Emergency cardio-pulmonary bypass in cardiac arrest: Seventeen years of experience
Emergency cardio-pulmonary bypass in cardiac arrest: Seventeen years of experience
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DOI：
10.1016/j.resuscitation.2012.05.029
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发表时间：
2013-03-01
期刊：
影响因子：
6.5
通讯作者：
Holzer, Michael
中科院分区：
文献类型：
--
作者：
Wallmueller, Christian;Sterz, Fritz;Holzer, Michael
目的：紧急体外循环(E-CPB)是一种先进的、很少使用的手术方法，适用于心脏骤停患者，但无法通过标准复苏方法恢复自主循环。方法：对在某三级医院急诊科接受E-CPB治疗的所有患者的临床表现、时间间隔、诊断和转归进行评估。回顾1993-2010年间所有患者的心脏骤停变量和治疗数据。结果：55例患者接受了E-CPB。在所有患者中，33名(60%)为男性，中位年龄为32岁(IQR24-44)。在所有病例中都出现了心脏骤停。首次记录的心电节律表现为无脉搏电活动23例(42%)，室颤21例(38%)，停搏11例(20%)。33例(60%)患者在院外发生心脏骤停。体外循环前心肺复苏时间的中位数为86min(IQR69~121)。中位插管时间为33min(IQR21~45)，转流时间为311min(IQR161~953)。19例(35%)患者出现心脏骤停。8例(15%)存活至6个月，神经功能恢复良好。结论：E-CPB治疗心脏骤停安全可行。在这个看似绝望的患者群体中，在长时间心脏骤停后，我们观察到了15%的高存活率。E-CPB是一种有意义的治疗选择，应该更经常和更早地考虑。(C)2012爱思唯尔爱尔兰有限公司。保留所有权利。
Aim: Emergency cardiopulmonary bypass (E-CPB) is an advanced and rarely used procedure for patients in cardiac arrest that do not regain restoration of spontaneous circulation with standard resuscitation methods. The feasibility, safety and outcome of the intervention with E-CPB in cardiac arrest situations at our department have been evaluated.Methods: Clinical presentation, time intervals, diagnosis and outcome of all patients who received E-CPB at an emergency department of a tertiary care university hospital were evaluated. Patient charts were reviewed regarding cardiac arrest variables and treatment data of all patients from 1993 to 2010.Results: E-CPB was performed in 55 patients. Of all patients, 33 (60%) were male and the median age was 32 years (IQR 24-44). In all cases cardiac arrest was witnessed. The first recorded ECG rhythm showed pulseless electric activity in 23 (42%), ventricular fibrillation in 21 (38%) and asystole in 11 (20%) patients. Cardiac arrest occurred out-of-hospital in 33 (60%) patients. The median duration of CPR before performing E-CPB was 86 min (IQR 69-121). The median 'cannulation'-time was 33 min (IQR 21-45) and the duration on bypass was 311 min (IQR 161-953). Cardiac causes of arrest were found in 19 (35%) patients. Eight patients (15%) survived to 6 months with good neurological outcome.Conclusion: E-CPB for cardiac arrest is feasible and safe. In this seemingly desperate patient population after prolonged cardiac arrest, we observed a high survival rate of 15%. E-CPB is a meaningful treatment option, which should be considered more often and earlier. (C) 2012 Elsevier Ireland Ltd. All rights reserved.