Abstract 18132: Multicenter Non-Randomized Prospective Cohort Study of Extracorporeal Cardiopulmonary Resuscitation for Out-of Hospital Cardiac Arrest: Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J)
Abstract 18132: Multicenter Non-Randomized Prospective Cohort Study of Extracorporeal Cardiopulmonary Resuscitation for Out-of Hospital Cardiac Arrest: Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J)
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摘要 18132：针对院外心脏骤停的体外心肺复苏的多中心非随机前瞻性队列研究：日本体外循环室颤高级生命支持研究 (SAVE-J)
DOI：
10.1161/circ.124.suppl_21.a18132
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发表时间：
2011
期刊：
影响因子：
37.8
通讯作者：
S. Nara
中科院分区：
文献类型：
--
作者：
T. Sakamoto;Yasufumi Asai;K. Nagao;H. Yokota;N. Morimura;Y. Tahara;T. Atsumi;M. Hase;S. Nara
背景：
本研究旨在探讨体外心肺复苏 (ECPR) 对院外心脏骤停 (OHCA) 合并室颤 (VF) 或无脉性室性心动过速 (VT) 患者的疗效。
方法：
本研究的设计是一项多中心非随机前瞻性队列研究。假设 ECPR 和传统高级生命支持 (ALS) 之间的 OHCA 合并 VF 或无脉性 VT 的结果相似。 2008年10月至2010年12月期间，46家三级急救医院参与了本次研究。患者纳入标准为 1) 现场出现心室颤动或无脉性 VT，2) 到达医院时心脏骤停，3) 接到电话到达医院后 45 分钟内，以及 4) 到达医院后 15 分钟内通过常规 ALS 未出现 ROSC。排除标准为 1) 年龄：75 岁，2) 日常生活活动能力差，3) 未经心脏证实的心脏骤停，以及 4) 体温过低。根据纳入标准，26 家医院（ECPR 组）采用 ECPR 治疗 OHCA，20 家医院（非 ECPR 组）计划采用常规 ALS。两组（意向治疗）均通过卡方检验和费舍尔精确概率检验，分析 1 个月时格拉斯哥-匹兹堡大脑表现和总体表现类别评估的良好结果（CPC1 或 2）患者的比例。
结果：
ECPR组180例患者入组，非ECPR组134例患者入组。 ECPR组与非ECPR组背景无差异；平均年龄（56.0 VS 56.9）、目击者（72.8% VS 75.4%）、非专业施救者心肺复苏（49.4% VS 45.5%）、急性冠状动脉综合征（65.6% VS 61.4%）、从昏倒到急诊室的分钟数（26.8 VS 30.0）。 ECPR 组的良好结局率（12.4%，22 例患者）显着高于非 ECPR 组（1.6%，2 例患者）（p<0.001）。
结论：
体外心肺复苏可能会在到达医院后 15 分钟内通过常规 ALS 改善院外心脏骤停伴心室颤动或无脉性室速而无 ROSC 的结果。
Background:
This study is aimed to examine the efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) for patients in out-of hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
Method:
The design of this study is a multicenter non-randomized prospective cohort study. Hypothesis is that the outcome of OHCA with VF or pulseless VT is similar between ECPR and conventional advanced life support (ALS). During from Oct. 2008 to Dec. 2010, forty six tertiary emergency hospitals were participated in this study. Patient inclusion criteria were 1) VF or pulseless VT on scene, 2) cardiac arrest on arrival at hospital, 3) within 45 minutes from a call to an arrival of hospital, and 4) non-ROSC by conventional ALS during 15 minutes after an arrival at hospital. Exclusion criteria were 1) age: 75 yr, 2) poor activities of daily livings, 3) non-cardiac verified cardiac arrest, and 4) hypothermia. According to the inclusion criteria, ECPR was adopted for OHCA in 26 hospitals (ECPR group) and conventional ALS was planned in 20 hospitals (non-ECPR group). Both groups (Intention-to-treat) were analyzed about the proportion of patients with favorable outcome (CPC1 or 2) assessed with the Glasgow-Pittsburgh Cerebral Performance and Overall Performance Categories at 1 month by chi square test and Fisher exact probability test.
Results:
One hundred and eighty patients of ECPR group and 134 patients of non-ECPR group were enrolled. There was no difference between the background of ECPR group and non-ECPR group; Average age (56.0 VS 56.9), Witnessed (72.8% VS 75.4%), Lay-rescuer CPR (49.4% VS 45.5%), Acute coronary syndrome (65.6% VS 61.4%), Minutes from collapse to emergency department (26.8 VS 30.0). The favorable outcome rate in ECPR group (12.4%, 22 patients) was statistically higher than the rate in non-ECPR group (1.6%, two patients) (p<0.001).
Conclusion:
Extracorporeal cardiopulmonary resuscitation may improve the outcome of out-of hospital cardiac arrest with VF or pulseless VT without ROSC by conventional ALS during 15 minutes after an arrival at hospital.