Extracorporeal resuscitation of cardiac arrest
Extracorporeal resuscitation of cardiac arrest
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DOI：
10.1111/j.1553-2712.1999.tb00438.x
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发表时间：
1999-07-01
影响因子：
4.4
通讯作者：
Bartlett, RH
中科院分区：
文献类型：
--
作者：
Younger, JG;Schreiner, RJ;Bartlett, RH
目的：心脏骤停（ECPR）期间的心肺功能体外支持（静脉动脉灌注）已被提倡作为提高心脏骤停后生存率的一种手段。作者回顾性地回顾了他们机构在这种干预方面的七年经验。方法：急诊科患者和住院患者在心脏骤停或休息后立即被认为是候选人。使用静脉动脉旁路术建立ECPR，并持续至患者恢复足够的心肺功能以允许脱离器械或直至其病情被认为不可恢复。结果：25例患者尝试ECPR，21例成功。4例患者（16%）从ECPR转为心室辅助装置，其中2例存活并等待移植。另外7名患者出院，总生存率为36%。由于接受治疗的儿童无一存活，因此存活者的年龄有增高的趋势（存活者40 +/- 14岁，非存活者33 +/- 15岁，p = 0.29）。存活者的常规CPR持续时间较短（存活者21 +/- 16 min，死亡者43 +/- 32 min，p = 0.04），体外支持持续时间也较短（存活者44 +/- 21 hr，死亡者87 +/- 96 hr，p = 0.18）。存活率仅见于那些病情适合明确治疗干预的患者，特别是由于呼吸或肺栓塞疾病导致的心脏骤停。虽然在艾德治疗的5名患者中有4名获得成功支持，但无一人存活出院。结论：在选择的可逆性疾病患者中，体外CPR可用于成功治疗心脏骤停。有必要进一步研究其最适当的应用。
Objective: Extracorporeal support of heart and lung function (venoarterial perfusion) during cardiac arrest (ECPR) has been advocated as a means of improving survival following cardiac arrest. The authors retrospectively reviewed their institution's seven-year experience with this intervention. Methods: Emergency department patients and inpatients in cardiac arrest or immediately postarrest were considered candidates. ECPR was instituted using venoarterial bypass and was continued until patients regained sufficient cardiopulmonary function to allow weaning from the device or until their condition was deemed irrecoverable. Results: ECPR was attempted in 25 patients and successfully instituted in 21. Four patients (16%) were converted from ECPR to ventricular assist devices, two of whom survived and await transplantation. Seven additional patients were discharged from the hospital,resulting in an overall survival of 36%. Because none of the children treated survived, there was a trend toward higher age among survivors (survivors 40 +/- 14 yr, nonsurvivors 33 +/- 15 yr, p = 0.29). The duration of conventional CPR was shorter among survivors (survivors 21 +/- 16 min, nonsurvivors 43 +/- 32 min, p = 0.04), as was the duration of extracorporeal support(survivors 44 +/- 21 hr, nonsurvivors 87 +/- 96 hr, p = 0.18). Survival was seen only in patients whose conditions were amenable to a definitive therapeutic intervention, particularly cardiac arrest due to respiratory or pulmonary embolic disease. While four of the five patients treated in the ED were successfully supported, none survived to discharge. Conclusion: In select patients with reversible disease, extracorporeal CPR can be used to successfully treat cardiac arrest. Further investigation into its most appropriate application is warranted.