Inoue Fumiya, Otani Takayuki, Abe Toshikazu, Inoue Akihiko, Hifumi Toru, Sakamoto Tetsuya, Kuroda Yasuhiro
Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima-city, Hiroshima, Japan.
Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima-city, Hiroshima, Japan.
J Emerg Med. 2025 Feb;69:1-12. doi: 10.1016/j.jemermed.2024.08.014. Epub 2024 Aug 24.
Intracranial hemorrhage (ICH) and acute aortic syndrome (AAS) are etiologies associated with unfavorable outcomes in patients with out-of-hospital cardiac arrest (OHCA), even with extracorporeal cardiopulmonary resuscitation (ECPR).
This study aimed to describe the characteristics of refractory OHCA patients resuscitated with ECPR due to ICH and AAS.
This was a descriptive study and a secondary analysis of the SAVE-J II study, which was a multicenter ECPR registry.
Among the 1589 cases, the causes of arrest were ICH in 48 patients (3%), AAS in 112 patients (7%), and cardiac causes in 1429 patients (90%). Patients in the ICH group were younger (ICH: 47 years [interquartile ranges (IQR) 40-63], AAS: 68 years [IQR 59-74], cardiac causes: 61 years [IQR 50-68]; p < 0.001), and had fewer signs of life on hospital arrival (ICH: 2%, AAS: 12%, cardiac causes: 19%; p = 0.001) compared to the cardiac causes group. Patients in the ICH and AAS groups were also less likely to present with an initial shockable rhythm (ICH, 19%; AAS, 27%; cardiac causes, 74%; p < 0.001). Survival to hospital discharge was significantly lower in the ICH and AAS groups than in the cardiac cause group (ICH, 4%; AAS, 4%; cardiac causes, 29%; p < 0.001). Of the 112 patients in the AAS group, 54 (48%) were presumptively diagnosed as cardiac etiologies before ECPR.
ICH and AAS should be considered potential causes of cardiac arrest, especially in cases with a nonshockable initial cardiac rhythm. However, differentiating them from cardiac causes of arrest remains challenging.
颅内出血（ICH）和急性主动脉综合征（AAS）是院外心脏骤停（OHCA）患者预后不良的病因，即使采用体外心肺复苏（ECPR）也是如此。
本研究旨在描述因ICH和AAS接受ECPR复苏的难治性OHCA患者的特征。
这是一项描述性研究，也是对SAVE-J II研究的二次分析，SAVE-J II研究是一个多中心ECPR登记处。
在1589例病例中，心脏骤停的原因是48例（3%）为ICH，112例（7%）为AAS，1429例（90%）为心脏原因。与心脏原因组相比，ICH组患者更年轻（ICH：47岁[四分位间距（IQR）40 - 63]，AAS：68岁[IQR 59 - 74]，心脏原因：61岁[IQR 50 - 68]；p < 0.001），且入院时生命体征较少（ICH：2%，AAS：12%，心脏原因：19%；p = 0.001）。ICH组和AAS组患者出现初始可电击心律的可能性也较小（ICH，19%；AAS，27%；心脏原因，74%；p < 0.001）。ICH组和AAS组出院存活率显著低于心脏原因组（ICH，4%；AAS，4%；心脏原因，29%；p < 0.001）。在AAS组的112例患者中，54例（48%）在ECPR前被推定为心脏病因。
ICH和AAS应被视为心脏骤停的潜在原因，尤其是在初始心律不可电击的情况下。然而，将它们与心脏骤停原因区分开来仍然具有挑战性。
