Department of Emergency Medicine, Qilu Hospital, Shandong University, Jinan, China.
Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
Crit Care Med. 2024 Jun 1;52(6):e268-e278. doi: 10.1097/CCM.0000000000006223. Epub 2024 Mar 5.
Comparing the effects of extracorporeal cardiopulmonary resuscitation (ECPR) and conventional cardiopulmonary resuscitation (CCPR) on outcomes in patients with in-hospital cardiac arrest (IHCA) in China. The benefits of ECPR over CCPR in patients with IHCA remain controversial.
This article analyzed data from the BASeline Investigation of In-hospital Cardiac Arrest (BASIC-IHCA) study, which consecutively enrolled patients with IHCA from July 1, 2019, to December 31, 2020. Patients who received ECPR were selected as the case group and matched with patients who received CCPR as the control group by propensity score at a ratio of 1:4. A parallel questionnaire survey of participating hospitals was conducted, to collect data on ECPR cases from January 1, 2021 to November 30, 2021. The primary outcome was survival to discharge or 30-day survival.
We included 39 hospitals across 31 provinces in China.
Patients receiving cardiopulmonary resuscitation and without contraindications to ECPR were selected from the BASIC-IHCA database. Patients older than 75 years, not witnessed, or with cardiopulmonary resuscitation duration less than 10 min were excluded.
None.
A total of 4853 patients met the inclusion criteria before matching, with 34 undergoing ECPR (median age, 56.5 yr; 67.65% male) and 4819 underwent CCPR (median age, 59 yr; 64.52% male). There were 132 patients receiving CCPR and 33 patients receiving ECPR who were eventually matched. The ECPR group had significantly higher survival rates at discharge or 30-day survival (21.21% vs. 7.58%, p = 0.048). The ECPR group had significantly lower mortality rates (hazard ratio 0.57; 95% CI, 0.38-0.91) than the CCPR group at discharge or 30 days. Besides the BASIC-IHCA study, the volume of ECPR implementations and the survival rate of patients with ECPR (29.4% vs. 10.4%. p = 0.004) in participating hospitals significantly improved.
ECPR may be beneficial compared with CCPR for patient survival after IHCA and should be considered for eligible patients with IHCA.
比较体外心肺复苏（ECPR）与常规心肺复苏（CCPR）对中国院内心搏骤停（IHCA）患者结局的影响。ECPR 对 IHCA 患者的益处仍存在争议。
本文分析了 2019 年 7 月 1 日至 2020 年 12 月 31 日连续纳入的来自 BASeline Investigation of In-hospital Cardiac Arrest（BASIC-IHCA）研究的患者数据。接受 ECPR 的患者被选为病例组，并通过倾向性评分以 1:4 的比例与接受 CCPR 的患者匹配为对照组。对参与医院进行了平行问卷调查，以收集 2021 年 1 月 1 日至 2021 年 11 月 30 日 ECPR 病例的数据。主要结局为出院或 30 天生存率。
我们纳入了中国 31 个省的 39 家医院。
从 BASIC-IHCA 数据库中选择接受心肺复苏且无 ECPR 禁忌证的患者。排除年龄>75 岁、非目击或心肺复苏持续时间<10 min 的患者。
无。
在匹配前，共有 4853 例患者符合纳入标准，其中 34 例行 ECPR（中位年龄 56.5 岁；67.65%为男性），4819 例行 CCPR（中位年龄 59 岁；64.52%为男性）。有 132 例接受 CCPR 和 33 例接受 ECPR 的患者最终匹配。ECPR 组出院或 30 天生存率显著更高（21.21%比 7.58%，p=0.048）。ECPR 组出院或 30 天死亡率（风险比 0.57；95%CI，0.38-0.91）明显低于 CCPR 组。除 BASIC-IHCA 研究外，参与医院的 ECPR 实施量和 ECPR 患者生存率（29.4%比 10.4%，p=0.004）也显著提高。
与 CCPR 相比，ECPR 可能对 IHCA 后患者的生存有益，应考虑将其用于符合条件的 IHCA 患者。
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