2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic; Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic.
Resuscitation. 2024 Nov;204:110412. doi: 10.1016/j.resuscitation.2024.110412. Epub 2024 Oct 16.
The initial rhythm is a known predictor of survival in extracorporeal cardiopulmonary resuscitation (ECPR) patients. However, the effect of the rhythm at hospital admission on outcomes in these patients is less clear.
This observational, single-center study assessed the influence of the rhythm at hospital admission on 30-day survival and neurological outcomes at discharge in patients who underwent ECPR for out-of-hospital cardiac arrest (OHCA).
Between January 2012 and December 2023, 1,219 OHCA patients were admitted, and 210 received ECPR. Of these, 196 patients were analyzed. The average age was 52.9 years (±13), with 80.6 % male. The median time to ECPR initiation was 61 min (IQR 54-72). Patients with ventricular fibrillation as both the initial and admission rhythm had the highest 30-day survival rate (52 %: 35/67), while those with asystole in both instances had the lowest (6 %: 1/17, log-rank p < 0.00001). After adjusting for age, sex, initial rhythm, resuscitation time, location, bystander, and witnessed status, asystole at admission was linked to higher 30-day mortality (OR 4.03, 95 % CI 1.49-12.38, p = 0.009) and worse neurological outcomes (Cerebral Performance Category 3-5) at discharge (OR 4.61, 95 % CI 1.49-17.62, p = 0.013).
The rhythm at hospital admission affects ECPR outcomes. Patients presenting with and maintaining ventricular fibrillation have a higher chance of favorable neurological survival, whereas those presenting with or converting to asystole have poor outcomes. The rhythm at hospital admission appears to be a valuable criterion for deciding on ECPR initiation.
初始节律是体外心肺复苏（ECPR）患者生存的已知预测因素。然而，入院时节律对这些患者结局的影响尚不清楚。
这项观察性、单中心研究评估了入院时节律对因院外心脏骤停（OHCA）接受 ECPR 的患者 30 天生存率和出院时神经结局的影响。
2012 年 1 月至 2023 年 12 月，共收治 1219 例 OHCA 患者，其中 210 例行 ECPR。其中，196 例患者进行了分析。平均年龄为 52.9 岁（±13），80.6%为男性。ECPR 启动的中位时间为 61 分钟（IQR 54-72）。初始节律和入院时节律均为室颤的患者 30 天生存率最高（52%：35/67），而初始和入院时节律均为心搏停止的患者最低（6%：1/17，log-rank p<0.00001）。在校正年龄、性别、初始节律、复苏时间、地点、旁观者和目击者状态后，入院时的心搏停止与 30 天死亡率升高（OR 4.03，95%CI 1.49-12.38，p=0.009）和出院时神经结局较差（Cerebral Performance Category 3-5）（OR 4.61，95%CI 1.49-17.62，p=0.013）相关。
入院时的节律会影响 ECPR 的结果。入院时呈现并维持室颤的患者有更高的神经生存机会，而呈现或转为心搏停止的患者预后较差。入院时的节律似乎是决定是否启动 ECPR 的一个有价值的标准。
