Frykler Abazi Lis, Liliequist Andreas, Böhm Felix, Hedberg Magnus, Simonsson Moa, Bäckman Anders, Ax Malin, Braunschweig Frieder, Mellbin Linda, Linder Rickard, Svensson Leif, Jurga Juliane, Nordberg Per, Ringh Mattias, Forsberg Sune, Hollenberg Jacob
Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden.
Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Resusc Plus. 2024 Mar 7;18:100596. doi: 10.1016/j.resplu.2024.100596. eCollection 2024 Jun.
The aim of this study was to evaluate the implementation of a novel extra corporeal cardiopulmonary (ECPR) program in the greater Stockholm area with focus on feasibility, safety aspects and clinical outcomes.
Prospective observational study of ECPR program including patients with OHCA from January 2020 to December 2022, fulfilling ECPR criteria: age 18-65 years, initial shockable rhythm or pulseless electrical activity, witnessed arrest, bystander cardiopulmonary resuscitation and refractory arrest after three cycles of advance cardiac life support. The predefined time threshold from collapse to extracorporeal membrane oxygenation (ECMO) initiation was set at 60 min.
We included 95 patients. Of these, 22/95 (23%) had return of spontaneous circulation before ECMO initiation, 39/95 (41%) were excluded for ECMO and 34/95 (36%) had ECMO initiated out of which 23 patients were admitted alive to the ICU. ECMO-initiation within 60 min was met in 9%. In 6 patients vascular access was complicated, 2 patients had severe bleeding at access site requiring intervention. Survival to discharge among all cases was 25% (24/95). Among patients admitted to ICU on ECMO 39% (9/23) survived to discharge, of these 78% had cerebral performance category scale score 1-2 within 12 months. 8 out of 9 survivors had time from OHCA to ECMO-initiation >60 min.
The implementation of an ECPR protocol was feasible without any major, unexpected safety aspects but did not meet the intended target time intervals. Despite this, survival rates were similar to previous studies although most survivors had >60 min to ECMO-initiation.
本研究的目的是评估在大斯德哥尔摩地区实施一项新型体外心肺复苏（ECPR）计划，重点关注可行性、安全性和临床结果。
对2020年1月至2022年12月期间符合ECPR标准的院外心脏骤停（OHCA）患者进行ECPR计划的前瞻性观察研究，标准为：年龄18 - 65岁，初始可电击心律或无脉电活动，目击骤停，旁观者心肺复苏，以及在三个周期的高级心脏生命支持后仍为难治性骤停。从心脏骤停到开始体外膜肺氧合（ECMO）的预定义时间阈值设定为60分钟。
我们纳入了95例患者。其中，22/95（23%）在开始ECMO之前恢复自主循环，39/95（41%）被排除进行ECMO，34/95（36%）开始进行ECMO，其中23例患者存活入住重症监护病房（ICU）。9%的患者在60分钟内开始ECMO。6例患者血管通路出现并发症，2例患者在穿刺部位出现严重出血需要干预。所有病例的出院生存率为25%（24/95）。在接受ECMO并入住ICU的患者中，39%（9/23）存活出院，其中78%在12个月内脑功能分类量表评分为1 - 2分。9名幸存者中有8名从OHCA到开始ECMO的时间>60分钟。
实施ECPR方案是可行的，没有任何重大的、意外的安全问题，但未达到预期的目标时间间隔。尽管如此，生存率与先前的研究相似，尽管大多数幸存者从OHCA到开始ECMO的时间>60分钟。
