Mazzeffi Michael, Zaaqoq Akram, Curley Jonathan, Buchner Jessica, Wu Isaac, Beller Jared, Teman Nicholas, Glance Laurent
Department of Anesthesiology, University of Virginia, Charlottesville, VA.
INOVA Heart and Vascular Institute, Department of Medicine, Medical Critical Care Service, Fairfax, VA.
Crit Care Med. 2024 Dec 1;52(12):1906-1917. doi: 10.1097/CCM.0000000000006439. Epub 2024 Oct 9.
Explore whether extracorporeal cardiopulmonary resuscitation (ECPR) mortality differs by in-hospital cardiac arrest location and whether moving patients for cannulation impacts outcome.
Retrospective cohort study.
ECPR hospitals that report data to the Extracorporeal Life Support Organization (ELSO).
Patients having ECPR for in-hospital cardiac arrest between 2020 and 2023 with data in the ELSO registry.
None.
Patient demographics, comorbidities, pre-cardiac arrest conditions, pre-ECPR vasopressor use, cardiac arrest details, ECPR cannulation information, major complications, and in-hospital mortality were recorded. Multivariable logistic regression model was used to examine the associations between in-hospital mortality and 1) cardiac arrest location and 2) moving a patient for ECPR cannulation. A total of 2515 patients met enrollment criteria. The adjusted odds ratio (aOR) for mortality was increased in patients who had a cardiac arrest in the ICU (aOR, 1.85; 95% CI, 1.45-2.38; p < 0.001) and in patients who had a cardiac arrest in an acute care bed (aOR, 1.68; 95% CI, 1.09-2.58; p = 0.02) compared with the cardiac catheterization laboratory. Moving a patient for cannulation had no association with mortality (aOR, 0.70; 95% CI, 0.18-2.81; p = 0.62). Advanced patient age was associated with increased mortality. Specifically, patients 60-69 and patients 70 years old or older were more likely to die compared with patients younger than 30 years old (aOR, 1.71; 95% CI, 1.17-2.50; p = 0.006 and aOR, 2.27; 95% CI, 1.49-3.48; p < 0.001, respectively).
ECPR patients who experienced cardiac arrest in the ICU and in acute care hospital beds had increased odds of mortality compared with other locations. Moving patients for ECPR cannulation was not associated with improved outcomes.
探讨院内心脏骤停发生地点是否会影响体外心肺复苏（ECPR）的死亡率，以及转运患者进行插管操作是否会影响预后。
回顾性队列研究。
向体外生命支持组织（ELSO）报告数据的实施ECPR的医院。
2020年至2023年间因院内心脏骤停接受ECPR且ELSO登记册中有相关数据的患者。
无。
记录患者的人口统计学资料、合并症、心脏骤停前状况、ECPR前血管升压药使用情况、心脏骤停细节、ECPR插管信息、主要并发症及院内死亡率。采用多变量逻辑回归模型分析院内死亡率与以下因素的关联：1）心脏骤停发生地点；2）转运患者进行ECPR插管操作。共有2515例患者符合纳入标准。与在心导管室发生心脏骤停的患者相比，在重症监护病房（ICU）发生心脏骤停的患者死亡率调整比值比（aOR）升高（aOR，1.85；95%CI，1.45 - 2.38；p < 0.001），在急性护理床位发生心脏骤停的患者死亡率调整比值比也升高（aOR，1.68；95%CI，1.09 - 2.58；p = 0.02）。转运患者进行插管操作与死亡率无关（aOR，0.70；95%CI，0.18 - 2.81；p = 0.62）。高龄患者死亡率增加。具体而言，与年龄小于30岁的患者相比，60 - 69岁患者及70岁及以上患者死亡可能性更高（aOR分别为1.71；95%CI，1.17 - 2.50；p = 0.006及aOR，2.27；95%CI，1.49 - 3.48；p < 0.001）。
与其他地点相比，在ICU及急性护理医院床位发生心脏骤停的ECPR患者死亡几率增加。转运患者进行ECPR插管操作与改善预后无关。
