中国体外心肺复苏的临床特征：一项多中心回顾性研究。
Clinical characteristics of extracorporeal cardiopulmonary resuscitation in China: a multicenter retrospective study.
机构信息
Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
出版信息
BMC Anesthesiol. 2024 Jul 10;24(1):230. doi: 10.1186/s12871-024-02618-2.
PURPOSE
Extracorporeal cardiopulmonary resuscitation (ECPR) might markedly increase the survival of selected patients with refractory cardiac arrest. But the application situation and indications remained unclear.
MATERIALS AND METHODS
We respectively reviwed all adult patients who underwent ECPR from January 2017 to March 2021. Patient characteristics, initiation and management of ECMO, complications, and outcomes were collected and compared between the survivors and nonsurvivors. LASSO regression was used to screen risk factors. Multivariate logistic regression was performed with several parameters screened by LASSO regression.
RESULTS
Data were reported from 42 ECMO centers covering 19 provinces of China. A total of 648 patients were included in the study, including 491 (75.8%) males. There were 11 ECPR centers in 2017, and the number increased to 42 in 2020. The number of patients received ECPR increased from 33 in 2017 to 274 in 2020, and the survival rate increased from 24.2% to 33.6%. Neurological complications, renal replacement therapy, epinephrine dosage after ECMO, recovery of spontaneous circulation before ECMO, lactate clearance and shockable rhythm were risk factors independently associated with outcomes of whole process. Sex, recovery of spontaneous circulation before ECMO, lactate, shockable rhythm and causes of arrest were pre-ECMO risk factors independently affecting outcomes.
CONCLUSIONS
From January 2017 to March 2021, the numbers of ECPR centers and cases in mainland China increased gradually over time, as well as the survival rate. Pre-ECMO risk factors, especially recovery of spontaneous circulation before ECMO, shockable rhythm and lactate, are as important as post-ECMO management,. Neurological complications are vital risk factors after ECMO that deserved close attention.
TRIAL REGISTRATION
NCT04158479, registered on 2019/11/08. https://clinicaltrials.gov/NCT04158479.
目的
体外心肺复苏（ECPR）可能显著提高部分难治性心搏骤停患者的存活率。但是，其应用情况和适应证仍不明确。
材料与方法
我们分别回顾了 2017 年 1 月至 2021 年 3 月期间接受 ECPR 的所有成年患者。收集并比较了幸存者和非幸存者之间的患者特征、ECMO 的启动和管理、并发症和结局。使用 LASSO 回归筛选危险因素。使用 LASSO 回归筛选的几个参数进行多变量逻辑回归。
结果
研究数据来自中国 19 个省的 42 个 ECMO 中心。共有 648 名患者纳入研究，其中 491 名（75.8%）为男性。2017 年有 11 个 ECPR 中心，到 2020 年增加到 42 个。接受 ECPR 的患者人数从 2017 年的 33 人增加到 2020 年的 274 人，存活率从 24.2%增加到 33.6%。神经并发症、肾脏替代治疗、ECMO 后肾上腺素剂量、ECMO 前自主循环恢复、乳酸清除率和可电击节律是与整个过程结局相关的独立危险因素。性别、ECMO 前自主循环恢复、乳酸、可电击节律和停搏原因是影响预后的独立的 ECMO 前危险因素。
结论
2017 年 1 月至 2021 年 3 月期间，中国大陆 ECPR 中心和病例数量随时间逐渐增加，存活率也随之提高。ECPR 前危险因素，特别是 ECMO 前自主循环恢复、可电击节律和乳酸，与 ECMO 后管理同等重要，神经并发症是 ECMO 后至关重要的危险因素，值得密切关注。
试验注册
NCT04158479，注册于 2019 年 11 月 8 日。https://clinicaltrials.gov/NCT04158479。
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