Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial)
Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial)
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DOI：
10.1016/j.resuscitation.2014.09.010
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发表时间：
2015-01-01
期刊：
影响因子：
6.5
通讯作者：
Kaye, David M.
中科院分区：
文献类型：
--
作者：
Stub, Dion;Bernard, Stephen;Kaye, David M.
简介：许多心脏骤停的患者对标准心肺复苏没有反应。静脉-动脉体外膜肺氧合辅助心肺复苏（E-CPR）在难治性心脏骤停的治疗中越来越受到关注。我们描述了我们的初步经验，在建立一个电子心肺复苏程序难治性心脏骤停在墨尔本，Australia.Methods：CHEER试验（机械心肺复苏，低温，ECMO和早期再灌注）是一个单中心，前瞻性，观察性研究在阿尔弗雷德医院进行。CHEER方案是为选定的院内和院外难治性心脏骤停患者开发的，包括机械CPR、快速静脉注射30 mL/kg冰冷盐水以诱导骤停治疗性低温、由两名重症监护医生对股动脉和静脉进行经皮插管以及开始静脉-动脉ECMO。随后，疑似冠状动脉闭塞的患者被转移到心导管实验室进行冠状动脉造影。治疗性低温（33摄氏度）维持24小时，在重症监护室。结果：有26例患者符合CHEER协议（11与OHCA，15与IHCA）。中位年龄为52岁（IQR 38-60）。24例（92%）建立了ECMO，从虚脱到开始ECMO的中位时间为56（IQR 40-85）min。11例（42%）患者进行了经皮冠状动脉介入治疗，1例患者进行了肺栓塞切除术。25例（96%）患者恢复自主循环。ECMO支持的中位持续时间为2（IQR 1-5）天，13/24（54%）例患者成功脱离ECMO支持。生存出院与完全神经功能恢复（CPC评分1）发生在14/26（54%）patients.Conclusions：一个协议，包括电子心肺复苏术制定的重症监护医生难治性心脏骤停，其中包括机械心肺复苏术，围逮捕治疗性低温和ECMO是可行的，并与一个相对较高的生存率。(C)2014爱思唯尔爱尔兰有限公司版权所有。
Introduction: Many patients who suffer cardiac arrest do not respond to standard cardiopulmonary resuscitation. There is growing interest in utilizing veno-arterial extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (E-CPR) in the management of refractory cardiac arrest. We describe our preliminary experiences in establishing an E-CPR program for refractory cardiac arrest in Melbourne, Australia.Methods: The CHEER trial (mechanical CPR, Hypothermia, ECMO and Early Reperfusion) is a single center, prospective, observational study conducted at The Alfred Hospital. The CHEER protocol was developed for selected patients with refractory in-hospital and out-of-hospital cardiac arrest and involves mechanical CPR, rapid intravenous administration of 30 mL/kg of ice-cold saline to induce intra-arrest therapeutic hypothermia, percutaneous cannulation of the femoral artery and vein by two critical care physicians and commencement of veno-arterial ECMO. Subsequently, patients with suspected coronary artery occlusion are transferred to the cardiac catheterization laboratory for coronary angiography. Therapeutic hypothermia (33 degrees C) is maintained for 24 h in the intensive care unit.Results: There were 26 patients eligible for the CHEER protocol (11 with OHCA, 15 with IHCA). The median age was 52 (IQR 38-60) years. ECMO was established in 24 (92%), with a median time from collapse until initiation of ECMO of 56 (IQR 40-85) min. Percutaneous coronary intervention was performed on 11 (42%) and pulmonary embolectomy on 1 patient. Return of spontaneous circulation was achieved in 25 (96%) patients. Median duration of ECMO support was 2 (IQR 1-5) days, with 13/24 (54%) of patients successfully weaned from ECMO support. Survival to hospital discharge with full neurological recovery (CPC score 1) occurred in 14/26 (54%) patients.Conclusions: A protocol including E-CPR instituted by critical care physicians for refractory cardiac arrest which includes mechanical CPR, peri-arrest therapeutic hypothermia and ECMO is feasible and associated with a relatively high survival rate. (C) 2014 Elsevier Ireland Ltd. All rights reserved.