An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study.
An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study.
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DOI：
10.1186/s13054-014-0535-8
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发表时间：
2014-09-26
期刊：
影响因子：
--
通讯作者：
Lee SW
中科院分区：
文献类型：
--
作者：
Kim SJ;Jung JS;Park JH;Park JS;Hong YS;Lee SW
院外心脏骤停（OHCA）患者长期常规心肺复苏（CCPR）与不良预后相关。可能需要替代方法来改善持续CCPR患者的结局，体外心肺复苏（ECPR）可被视为替代方法。本研究的目的是估计CPR的最佳持续时间，以考虑ECPR作为CCPR患者的替代复苏方法，并找到预测接受ECPR的OHCA患者良好神经功能结局的指征。本研究是一项基于前瞻性队列的回顾性分析。我们纳入了2006年5月至2013年12月期间经历过OHCA且年龄≥ 18岁、无疑似或确诊创伤的患者。首先，我们根据仅接受CCPR的患者的良好和不良神经结局的区分来确定CPR的适当截止时间，然后我们通过使用倾向评分匹配来比较CCPR组和ECPR组之间的结局。其次，我们根据匹配的ECPR组的神经功能结局比较CPR相关数据。在适合入选的499例患者中，CCPR组和ECPR组分别入组了444例和55例患者。仅在CCPR患者中，有利的神经功能结局（CPC 1，2）的预测持续时间< 21分钟。CPR持续时间≥ 21分钟的匹配ECPR组在停搏后3个月时的神经功能结局比匹配CCPR组更有利。在匹配的ECPR组中，年龄较小、目睹了无初始心搏停止节律的心脏骤停、早期达到平均动脉压≥ 60 mmHg、ECPR相关并发症发生率低和治疗性低温是预期良好神经功能结局的重要因素。对于需要延长CPR（尤其是≥ 21分钟）的OHCA患者，应将ECPR视为获得良好神经结局的替代方法。年轻或有目击者的心搏骤停患者无初始心搏停止是ECPR的良好候选者。ECPR植入后，早期血流动力学稳定，预防ECPR相关并发症，以及应用治疗性低温可能会改善神经功能结局。
Prolonged conventional cardiopulmonary resuscitation (CCPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Alternative methods can be needed to improve the outcome in patients with prolonged CCPR and extracorporeal cardiopulmonary resuscitation (ECPR) can be considered as an alternative method. The objectives of this study were to estimate the optimal duration of CPR to consider ECPR as an alternative resuscitation method in patients with CCPR, and to find the indications for predicting good neurologic outcome in OHCA patients who received ECPR. This study is a retrospective analysis based on a prospective cohort. We included patients ≥ 18 years of age without suspected or confirmed trauma and who experienced an OHCA from May 2006 to December 2013. First, we determined the appropriate cut-off duration for CPR based on the discrimination of good and poor neurological outcomes in the patients who received only CCPR, and then we compared the outcome between the CCPR group and ECPR group by using propensity score matching. Second, we compared CPR related data according to the neurologic outcome in matched ECPR group. Of 499 patients suitable for inclusion, 444 and 55 patients were enrolled in the CCPR and ECPR group, respectively. The predicted duration for a favorable neurologic outcome (CPC1, 2) is < 21 minutes of CPR in only CCPR patients. The matched ECPR group with ≥ 21 minutes of CPR duration had a more favorable neurological outcome than the matched CCPR group at 3 months post-arrest. In matched ECPR group, younger age, witnessed arrest without initial asystole rhythm, early achievement of mean arterial pressure ≥ 60 mmHg, low rate of ECPR-related complications, and therapeutic hypothermia were significant factors for expecting good neurologic outcome. ECPR should be considered as an alternative method for attaining good neurological outcomes in OHCA patients who required prolonged CPR, especially of ≥ 21 minutes. Younger or witnessed arrest patients without initial asystole were good candidates for ECPR. After implantation of ECPR, early hemodynamic stabilization, prevention of ECPR-related complications, and application of therapeutic hypothermia may improve the neurological outcome.
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影响因子：
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