Liao Xiaozu, Gu Chen, Cheng Zhou, Liu Kepeng, Yin Qing, Li Binfei
Zhongshan City People's Hospital, Department of Anesthesiology, Zhongshan, China.
Zhongshan City People's Hospital, Department of Anesthesiology, Zhongshan, China.
Braz J Anesthesiol. 2025 May-Jun;75(3):844588. doi: 10.1016/j.bjane.2025.844588. Epub 2025 Jan 23.
Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis.
The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO-GDCPR groups based on whether ETCO was used as a guide for CPR.
A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000-1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR = 10.74, 95% CI 1.90-60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001-1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74-0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77-0.94, p < 0.01), while that for H-IL6 was 0.19 (0.09-0.29, p < 0.01).
ETCO-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.
体外心肺复苏（ECPR）是心脏骤停后恢复充足循环灌注的有效干预措施。在启动体外膜肺氧合（ECMO）之前确保高质量的心肺复苏（CPR）对于减轻组织缺氧和缺血至关重要。本研究旨在通过回顾性病例对照分析评估呼气末二氧化碳（ETCO）目标导向心肺复苏（GDCPR）对ECMO前神经功能的影响。
收集2020年1月至2023年3月在中山市人民医院接受ECPR治疗的所有患者的病历。在这项回顾性队列研究中，根据是否将ETCO用作CPR的指导，将患者分为传统心肺复苏（CCPR）组和ETCO-GDCPR组。
共纳入71例患者，其中46例为CCPR组，25例为GDCPR组。接受ECPR的患者中约37%在出院时脑功能良好，GDCPR组（52%）的比例高于CCPR组（28%）（p = 0.047）。多因素分析显示，ECMO后最高白细胞介素-6（H-IL6）水平（比值比[OR = 1.001]，95%置信区间[95%CI 1.000 - 1.003]，p = 0.005）是出院时神经功能的危险因素。接受ECPR患者预后不良的其他危险因素包括ECMO前的CPR方案（OR = 10.74，95%CI 1.90 - 60.48，p = 0.007）和ECMO后的IL6水平（OR = 1.002，95%CI 1.001 - 1.003，p = 0.005）。ECMO持续时间（OR = 0.83，95%CI 0.74 - 0.94，p = 0.002）被确定为保护因素。ECMO持续时间短的患者预后较差。ECMO持续时间的曲线下面积为0.86（0.77 - 0.94，p < 0.01），而H-IL6的曲线下面积为0.19（0.09 - 0.29，p < 0.01）。
ETCO指导的ECPR与改善神经预后和患者结局相关。因此，监测ETCO水平应被视为评估CPR期间复苏效果的关键组成部分。
