Gaisendrees Christopher, Schlachtenberger Georg, Müller Lynn, Jaeger Deborah, Djordjevic Ilija, Krasivskyi Ihor, Elederia Ahmed, Walter Sebastian, Vollmer Mattias, Weber Carolyn, Luehr Maximilian, Wahlers Thorsten
Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany.
INSERM U 1116, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France.
Resusc Plus. 2024 Mar 21;18:100613. doi: 10.1016/j.resplu.2024.100613. eCollection 2024 Jun.
Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used due to its beneficial outcomes and results compared to conventional CPR. Cardiac arrests can be categorized depending on location: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite this distinction, studies comparing the two are scarce, especially in comparing outcomes after ECPR. This study compared patient characteristics, cardiac arrest characteristics, and outcomes.
Between 2016 and 2022, patients who underwent ECPR for cardiac arrest at our institution were retrospectively analyzed, depending on the arrest location: IHCA and OHCA. We compared periprocedural characteristics and used multinomial regression analysis to indicate parameters contributing to a favorable outcome.
A total of n = 157 patients (100%) were analyzed (OHCA = 91; IHCA = 66). Upon admission, OHCA patients were younger (53.2 ± 12.4 vs. 59.2 ± 12.6 years) and predominantly male (91.1% vs. 66.7%, p=<0.001). The low-flow time was significantly shorter in IHCA patients (41.1 ± 27.4 mins) compared to OHCA (63.6 ± 25.1 mins). Despite this significant difference, in-hospital mortality was not significantly different in both groups (IHCA = 72.7% vs. OHCA = 76.9%, p = 0.31). Both groups' survival-to-discharge factors were CPR duration, low flow time, and lactate values upon ECMO initiation.
Survival-to-discharge for ECPR in IHCA and OHCA was around 25%, and there was no statistically significant difference between the two cohorts. Factors predicting survival were lower lactate levels before cannulation and lower low-flow time. As such, OHCA patients seem to tolerate longer low-flow times and thus metabolic impairments compared to IHCA patients and may be considered for ECMO cannulation on a broader time span than IHCA.
与传统心肺复苏相比，体外心肺复苏（ECPR）因其良好的效果而被越来越多地使用。心脏骤停可根据发生地点进行分类：院内心脏骤停（IHCA）和院外心脏骤停（OHCA）。尽管有这种区分，但比较两者的研究很少，尤其是在比较ECPR后的结果方面。本研究比较了患者特征、心脏骤停特征和结果。
2016年至2022年期间，对在本机构因心脏骤停接受ECPR的患者进行回顾性分析，根据心脏骤停发生地点分为：IHCA和OHCA。我们比较了围手术期特征，并使用多项回归分析来确定有助于获得良好结果的参数。
共分析了n = 157例患者（100%）（OHCA = 91例；IHCA = 66例）。入院时，OHCA患者更年轻（53.2±12.4岁 vs. 59.2±12.6岁），且男性占主导（91.1% vs. 66.7%，p<0.001）。与OHCA患者（63.6±25.1分钟）相比，IHCA患者的低流量时间明显更短（41.1±27.4分钟）。尽管存在这一显著差异，但两组的院内死亡率无显著差异（IHCA = 72.7% vs. OHCA = 76.9%，p = 0.31）。两组患者出院生存率的影响因素为心肺复苏持续时间、低流量时间和启动体外膜肺氧合（ECMO）时的乳酸值。
IHCA和OHCA患者接受ECPR后的出院生存率约为25%，两组之间无统计学显著差异。预测生存的因素是插管前较低的乳酸水平和较短的低流量时间。因此，与IHCA患者相比，OHCA患者似乎能耐受更长的低流量时间，从而耐受代谢损伤，并且在比IHCA患者更广泛的时间范围内可考虑进行ECMO插管。
