Tanizawa Shu, Kojima Mitsuaki, Shoko Tomohisa, Inoue Akihiko, Hifumi Toru, Sakamoto Tetsuya, Kuroda Yasuhiro
Emergency and Critical Care Centre, Tokyo Women's Medical University Adachi Medical Centre, 4-33-1, Kohoku, Adachi, Tokyo 123-8558, Japan.
Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
Resusc Plus. 2024 Jul 2;19:100705. doi: 10.1016/j.resplu.2024.100705. eCollection 2024 Sep.
Extracorporeal cardiopulmonary resuscitation (ECPR) is used to resuscitate patients with cardiac arrest; however, its effect in treating hypothermic cardiac arrest has not been well studied. Therefore, in this study, we aimed to examine the characteristics and outcomes of patients with hypothermic cardiac arrest who underwent ECPR, using a multicenter out-of-hospital cardiac arrest (OHCA) registry in Japan.
Baseline characteristics of patients with hypothermic OHCA and body temperature below 32 °C were assessed. Logistic regression analysis was performed to identify factors associated with in-hospital mortality and neurological outcomes in these patients. Outcomes of hypothermic and cardiogenic OHCA cases were compared using propensity-score matching to investigate differences among subgroups.
We included 2,157 patients, with 102 and 1,646 in the hypothermic and cardiogenic groups, respectively. Higher age and longer low-flow time were independent risk factors for mortality, and higher age was an independent risk factor for unfavorable neurological outcomes in the hypothermic OHCA group.Eighty matched pairs were selected during propensity-score matching, and the mortality rate was lower in the hypothermic group than in the cardiogenic group (46.2% vs. 77.5%; p < 0.01). Unfavorable neurological outcome rate was lower in the hypothermic group than in the cardiogenic group (62.5% vs. 87.5%; p < 0.01).
Increased age and prolonged low-flow time were identified as negative prognostic factors in patients with hypothermic OHCA who underwent ECPR. These patients showed lower mortality and unfavorable neurological outcome rates than patients with cardiogenic OHCA, suggesting that ECPR is a promising strategy for treating hypothermic OHCA.
体外心肺复苏（ECPR）用于心脏骤停患者的复苏；然而，其在治疗低温性心脏骤停方面的效果尚未得到充分研究。因此，在本研究中，我们旨在利用日本的一个多中心院外心脏骤停（OHCA）登记系统，研究接受ECPR的低温性心脏骤停患者的特征和预后。
评估体温低于32°C的低温性OHCA患者的基线特征。进行逻辑回归分析以确定这些患者院内死亡和神经学预后的相关因素。使用倾向评分匹配比较低温性和心源性OHCA病例的预后，以研究亚组间的差异。
我们纳入了2157例患者，低温性组和心源性组分别有102例和1646例。年龄较大和低流量时间较长是死亡的独立危险因素，在低温性OHCA组中，年龄较大是不良神经学预后的独立危险因素。倾向评分匹配过程中选取了80对匹配病例，低温性组的死亡率低于心源性组（46.2%对77.5%；p<0.01）。低温性组的不良神经学预后率低于心源性组（62.5%对87.5%；p<0.01）。
年龄增加和低流量时间延长被确定为接受ECPR的低温性OHCA患者的不良预后因素。这些患者的死亡率和不良神经学预后率低于心源性OHCA患者，表明ECPR是治疗低温性OHCA的一种有前景的策略。
