Extracorporeal cardiopulmonary resuscitation in out-of-hosiital cardiac arrest: a registry study
Extracorporeal cardiopulmonary resuscitation in out-of-hosiital cardiac arrest: a registry study
复制标题
DOI：
10.1093/eurheartj/ehz753
复制
发表时间：
2020-06-01
影响因子：
39.3
通讯作者：
Jouven, Xavier
中科院分区：
文献类型：
--
作者：
Bougouin, Wulfran;Dumas, Florence;Jouven, Xavier
目的院外心脏骤停（OHCA）虽经常规复苏但无自发循环恢复（ROSC）是一种常见且预后较差的情况。在心肺复苏（extracorporeal- cpr）中加入体外膜氧合（ECMO）越来越多地用于改善预后。方法和结果我们分析了2011年5月至2018年1月期间巴黎地区13191例ohca的前瞻性登记。我们比较了体外心肺复苏术和不进行体外心肺复苏术患者出院时的生存率，并确定了与体外心肺复苏术患者生存率相关的因素。525例体外心肺复苏患者的生存率为8%，12666例常规心肺复苏患者的生存率为9% （P = 0.91）。经调整多因素分析，体外心肺复苏与住院生存率无关[优势比（OR）， 1.3；95%置信区间（95% CI）， 0.8-2.1；P = 0.24]。通过条件logistic回归匹配倾向评分（包括年龄、性别、家中发生情况、旁观者CPR、初始节律、崩溃至CPR时间、复苏持续时间和ROSC），发现相似的结果（OR为0.8；95% CI为0.5-1.3;P = 0.41）。在体外心肺复苏组，与住院生存率相关的因素是初始休克节律（OR, 3.9; 95% CI, 1.5-10.3; P = 0.005）、ECMO前短暂性ROSC （OR, 2.3; 95% CI, 1.1-4.7; P = 0.03）和院前ECMO植入（OR, 2.9; 95% CI, 1.5-5.9; P = 0.002）。结论：在一项基于人群的登记中，4%的ohca接受了体外心肺复苏术治疗，这与住院生存率的增加无关。早期ECMO植入可改善预后。初始心律和ROSC可能有助于选择体外心肺复苏术患者。
Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8-2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5-1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5-10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1-4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5-5.9; P = 0.002).Conclusion In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.