Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study.
Variability of extracorporeal cardiopulmonary resuscitation utilization for refractory adult out-of-hospital cardiac arrest: an international survey study.
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DOI：
10.15441/ceem.17.219
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发表时间：
2018-06
影响因子：
1.9
通讯作者：
Korean Hypothermia Network Investigators and the National Post-Arrest Research Consortium
中科院分区：
文献类型：
--
作者：
Coppler PJ;Abella BS;Callaway CW;Chae MK;Choi SP;Elmer J;Kim WY;Kim YM;Kurz M;Oh JS;Reynolds JC;Rittenberger JC;Sawyer KN;Youn CS;Lee BK;Gaieski DF;Korean Hypothermia Network Investigators and the National Post-Arrest Research Consortium
目前，体外心肺复苏（ECPR）作为难治性成人院外心脏骤停（OHCA）的抢救策略越来越受到关注。本研究旨在确定美国和韩国ECPR患者的当前护理标准和实践变化。2015年12月，我们调查了韩国低温网络（KORHN）研究者和美国国家逮捕后研究联盟（NPARC）的中心，了解当前的目标温度管理和ECPR实践。这个项目分析了解决ECPR实践问题的部分。我们使用描述性统计对调查结果进行了总结。总体而言，9家KORHN和4家NPARC中心报告开展了ECPR项目，并提供了完整的调查数据。两个KORHN中心仅将体外膜肺氧合用于难治性休克患者的休息后循环支持，并从进一步分析中排除。具有可用ECPR的中心通常看到大量OHCA患者（10/11的中心每年护理>75 OHCA）。各中心的位置和接受插管培训的提供者各不相同。这两个国家的所有中心（KORHN 7/7，NPARC 4/4）都对昏迷的ECPR患者进行了有针对性的体温管理。所有NPARC中心和7个KORHN中心中的4个报告了ECPR的标准化医院方案。符合资格的年龄上限为60至75岁。各中心之间没有一致的绝对禁忌症。在美国和韩国对难治性OHCA进行ECPR的中心之间，实践模式存在很大差异。标准化的方案和共享的研究数据库可以为最佳实践提供信息，改善结果，并为前瞻性研究提供基础。
A growing interest in extracorporeal cardiopulmonary resuscitation (ECPR) as a rescue strategy for refractory adult out-of-hospital cardiac arrest (OHCA) currently exists. This study aims to determine current standards of care and practice variation for ECPR patients in the USA and Korea. In December 2015, we surveyed centers from the Korean Hypothermia Network (KORHN) Investigators and the US National Post-Arrest Research Consortium (NPARC) on current targeted temperature management and ECPR practices. This project analyzes the subsection of questions addressing ECPR practices. We summarized survey results using descriptive statistics. Overall, 9 KORHN and 4 NPARC centers reported having ECPR programs and had complete survey data available. Two KORHN centers utilized extracorporeal membrane oxygenation only for postarrest circulatory support in patients with refractory shock and were excluded from further analysis. Centers with available ECPR generally saw a high volume of OHCA patients (10/11 centers care for >75 OHCA a year). Location of, and providers trained for cannulation varied across centers. All centers in both countries (KORHN 7/7, NPARC 4/4) treated comatose ECPR patients with targeted temperature management. All NPARC centers and four of seven KORHN centers reported having a standardized hospital protocol for ECPR. Upper age cutoff for eligibility ranged from 60 to 75 years. No absolute contraindications were unanimous among centers. A wide variability in practice patterns exist between centers performing ECPR for refractory OHCA in the US and Korea. Standardized protocols and shared research databases might inform best practices, improve outcomes, and provide a foundation for prospective studies.