Trummer Georg, Benk Christoph, Pooth Jan-Steffen, Wengenmayer Tobias, Supady Alexander, Staudacher Dawid L, Damjanovic Domagoj, Lunz Dirk, Wiest Clemens, Aubin Hug, Lichtenberg Artur, Dünser Martin W, Szasz Johannes, Dos Reis Miranda Dinis, van Thiel Robert J, Gummert Jan, Kirschning Thomas, Tigges Eike, Willems Stephan, Beyersdorf Friedhelm
Department of Cardiovascular Surgery, University Medical Center Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
Faculty of Medicine, Albert-Ludwigs-University Freiburg, Breisacherstr. 153, 79110 Freiburg, Germany.
J Clin Med. 2023 Dec 21;13(1):56. doi: 10.3390/jcm13010056.
Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6-26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment of the causative condition. We developed a new strategy to address these issues. This all-comers, multicenter, prospective observational study (69 patients with in- and out-of-hospital CA (IHCA and OHCA) after prolonged refractory CCPR) focused on extracorporeal cardiopulmonary support, comprehensive monitoring, multi-organ repair, and the potential for out-of-hospital cannulation and treatment. The overall survival rate at hospital discharge was 42.0%, and a favorable neurological outcome (CPC 1+2) at 90 days was achieved for 79.3% of survivors (CPC 1+2 survival 33%). IHCA survival was very favorable (51.7%), as was CPC 1+2 survival at 90 days (41%). Survival of OHCA patients was 35% and CPC 1+2 survival at 90 days was 28%. The subgroup of OHCA patients with pre-hospital cannulation showed a superior survival rate of 57.1%. This new strategy focusing on repairing damage to multiple organs appears to improve outcomes after CA, and these findings should provide a sound basis for further research in this area.
心脏骤停（CA）后，传统心肺复苏（CCPR）的生存率仍然很低（6%-26%），体外心肺复苏（ECPR）后的结果也常常不一致。生存率低是CA、CCPR期间的低血流状态、多器官损伤、监测不足以及致病状况治疗延迟的结果。我们制定了一项新策略来解决这些问题。这项针对所有患者的多中心前瞻性观察性研究（69例在长时间难治性CCPR后发生院内心脏骤停和院外心脏骤停（IHCA和OHCA）的患者）聚焦于体外心肺支持、全面监测、多器官修复以及院外插管和治疗的可能性。出院时的总体生存率为42.0%，79.3%的幸存者在90天时获得了良好的神经学预后（脑功能分级1+2级）（脑功能分级1+2级生存率为33%）。IHCA的生存率非常可观（51.7%），90天时脑功能分级1+2级的生存率也是如此（41%）。OHCA患者的生存率为35%，90天时脑功能分级1+2级的生存率为28%。院前插管的OHCA患者亚组的生存率更高，为57.1%。这项专注于修复多器官损伤的新策略似乎改善了CA后的预后，这些发现应为该领域的进一步研究提供坚实的基础。
