Nakashima Takahiro, Arai Marina, Inoue Akihiko, Hifumi Toru, Sakamoto Tetsuya, Kuroda Yasuhiro, Tahara Yoshio
Department of Emergency Medicine and The Harry Max Weil Institute for Critical Care Research and InnovationUniversity of Michigan, Ann Arbor, Michigan, USA.
Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Centre, Suita, Japan.
JACC Adv. 2024 Dec 13;4(1):101455. doi: 10.1016/j.jacadv.2024.101455. eCollection 2025 Jan.
Extracorporeal cardiopulmonary resuscitation (ECPR) has allowed patients with refractory out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI) to receive primary percutaneous coronary intervention (PCI); they were previously ineligible.
The purpose of this study was to clarify the characteristics and outcomes of patients with OHCA secondary to AMI who underwent primary PCI during refractory cardiac arrest despite ECPR.
Patients with AMI and OHCA aged ≥18 years who underwent PCI with ECPR in 2013 to 2018 were identified from a multicenter ECPR registry in Japan. The primary outcome was in-hospital mortality. We also assessed possible predictors of survival to discharge using mixed effects logistic regression to account for group differences among facilities.
Among 671 patients with AMI and OHCA who underwent PCI with ECPR from 30 institutions, 251 (37%) patients had refractory cardiac arrest despite ECPR initiation and subsequently underwent primary PCI. Following coronary reperfusion, 64.9% (163/251) of patients achieved the sustained return of spontaneous circulation (ROSC), 21.1% (53/251) survived, and 10.4% (26/251) had favorable neurological status at hospital discharge. Multivariable analysis revealed that intermittent prehospital ROSC (OR: 5.22; 95% CI: 1.54-17.79), shorter time to ECPR initiation (OR: 0.89; 95% CI: 0.82-0.98), and postprocedural TIMI flow grade 3 (OR: 5.08; 95% CI: 1.50-17.22) are significantly associated with survival to hospital discharge.
Among patients with AMI and refractory OHCA treated with ECPR, one-third did not have sustained ROSC prior to PCI. Of those, two-thirds achieved sustained ROSC following reperfusion and one-fifth survived to discharge.
体外心肺复苏（ECPR）使因急性心肌梗死（AMI）导致院外心脏骤停（OHCA）难治的患者能够接受直接经皮冠状动脉介入治疗（PCI）；他们之前不符合条件。
本研究的目的是阐明在难治性心脏骤停期间尽管进行了ECPR仍接受直接PCI的AMI继发OHCA患者的特征和结局。
从日本的一个多中心ECPR登记处识别出2013年至2018年期间年龄≥18岁、因AMI和OHCA接受ECPR辅助PCI的患者。主要结局是院内死亡率。我们还使用混合效应逻辑回归评估出院存活的可能预测因素，以考虑各机构之间的组间差异。
在来自30个机构的671例因AMI和OHCA接受ECPR辅助PCI的患者中，251例（37%）患者尽管开始了ECPR仍发生难治性心脏骤停，随后接受了直接PCI。冠状动脉再灌注后，64.9%（163/251）的患者实现了自主循环持续恢复（ROSC），21.1%（53/251）存活，10.4%（26/251）在出院时具有良好的神经功能状态。多变量分析显示，院外间歇性ROSC（比值比：5.22；95%置信区间：1.54-17.79）、开始ECPR的时间较短（比值比：0.89；95%置信区间：0.82-0.98）以及术后心肌梗死溶栓治疗（TIMI）血流分级3级（比值比：5.08；95%置信区间：1.50-17.22）与出院存活显著相关。
在接受ECPR治疗的AMI和难治性OHCA患者中，三分之一在PCI之前没有实现持续ROSC。其中，三分之二在再灌注后实现了持续ROSC，五分之一存活至出院。
