体外心肺复苏术在小儿心脏手术后的应用较常规心肺复苏术提高了生存率：对 Get With The Guidelines-Resuscitation 注册研究的分析结果。
Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry.
机构信息
Departments of Cardiology & Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
出版信息
Crit Care Med. 2024 Apr 1;52(4):563-573. doi: 10.1097/CCM.0000000000006103. Epub 2023 Nov 8.
OBJECTIVES
Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation (CPR) is increasingly used in children suffering cardiac arrest after cardiac surgery. However, its efficacy in promoting survival has not been evaluated. We compared survival of pediatric cardiac surgery patients suffering in-hospital cardiac arrest who were resuscitated with extracorporeal CPR (E-CPR) to those resuscitated with conventional CPR (C-CPR) using propensity matching.
DESIGN
Retrospective study using multicenter data from the American Heart Association Get With The Guidelines-Resuscitation registry (2008-2020).
SETTING
Multicenter cardiac arrest database containing cardiac arrest and CPR data from U.S. hospitals.
PATIENTS
Cardiac surgical patients younger than 18 years old who suffered in-hospital cardiac arrest and received greater than or equal to 10 minutes of CPR.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Among 1223 patients, 741 (60.6%) received C-CPR and 482 (39.4%) received E-CPR. E-CPR utilization increased over the study period ( p < 0.001). Duration of CPR was longer in E-CPR compared with C-CPR recipients (42 vs. 26 min; p < 0.001). In a propensity score matched cohort (382 E-CPR recipients, 382 C-CPR recipients), E-CPR recipients had survival to discharge (odds ratio [OR], 2.22; 95% CI, 1.7-2.9; p < 0.001). E-CPR survival was only higher when CPR duration was greater than 18 minutes. Propensity matched analysis using patients from institutions contributing at least one E-CPR case ( n = 35 centers; 353 E-CPR recipients, 353 C-CPR recipients) similarly demonstrated improved survival in E-CPR recipients compared with those who received C-CPR alone (OR, 2.08; 95% CI, 1.6-2.8; p < 0.001).
CONCLUSIONS
E-CPR compared with C-CPR improved survival in children suffering cardiac arrest after cardiac surgery requiring CPR greater than or equal to 10 minutes.
目的
体外膜肺氧合（ECPR）支持心肺复苏（CPR）越来越多地用于心脏手术后发生心搏骤停的儿童。然而，其在促进生存方面的疗效尚未得到评估。我们使用倾向评分匹配比较了接受体外心肺复苏（E-CPR）复苏和接受常规心肺复苏（C-CPR）复苏的接受心脏手术后发生院内心搏骤停的儿科心脏手术患者的存活率。
设计
回顾性研究，使用美国心脏协会 Get With The Guidelines-Resuscitation 注册中心（2008-2020 年）的多中心数据。
地点
包含美国医院心脏骤停和 CPR 数据的多中心心脏骤停数据库。
患者
年龄小于 18 岁，接受过 10 分钟或更长时间 CPR 的心脏手术患者。
干预措施
无。
测量和主要结果
在 1223 例患者中，741 例（60.6%）接受 C-CPR，482 例（39.4%）接受 E-CPR。在研究期间，E-CPR 的使用率增加（p<0.001）。与 C-CPR 组相比，E-CPR 组 CPR 时间更长（42 分钟与 26 分钟；p<0.001）。在倾向评分匹配队列中（382 例 E-CPR 患者，382 例 C-CPR 患者），E-CPR 患者的出院存活率更高（优势比[OR]，2.22；95%置信区间，1.7-2.9；p<0.001）。只有当 CPR 时间大于 18 分钟时，E-CPR 的存活率才更高。使用至少有一个 E-CPR 病例的机构的患者进行倾向匹配分析（n=35 个中心；353 例 E-CPR 患者，353 例 C-CPR 患者），同样显示与单独接受 C-CPR 相比，E-CPR 组的存活率更高（OR，2.08；95%置信区间，1.6-2.8；p<0.001）。
结论
与 C-CPR 相比，在接受 10 分钟或更长时间 CPR 的心脏手术后发生心搏骤停的儿童中，E-CPR 可提高生存率。
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