Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience

被引:71
|
作者
Dennis, Mark [1 ,2 ]
McCanny, Peter [3 ]
D'Souza, Mario [4 ]
Forrest, Paul [1 ,6 ]
Burns, Brian [1 ,5 ]
Lowe, David A. [3 ]
Gattas, David [1 ,7 ]
Scott, Sean [8 ]
Bannon, Paul [1 ,9 ]
Granger, Emily [10 ]
Pye, Roger [3 ]
Totaro, Richard [1 ,7 ]
机构
[1] Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia
[2] Royal Prince Alfred Hosp, Dept Cardiol, Sydney, NSW, Australia
[3] St Vincents Hosp, Dept Intens Care, Sydney, NSW, Australia
[4] Sydney Local Hlth Dist, Clin Res Ctr, Sydney, NSW, Australia
[5] Greater Sydney Area Helicopter Emergency Med Serv, New South Wales Ambulance Serv, Sydney, NSW, Australia
[6] Royal Prince Alfred Hosp, Dept Cardiothorac Anaesthesia, Sydney, NSW, Australia
[7] Royal Prince Alfred Hosp, Dept Intens Care, Sydney, NSW, Australia
[8] St Vincents Hosp, Dept Emergency Med, Sydney, NSW, Australia
[9] Royal Prince Alfred Hosp, Inst Acad Surg, Sydney, NSW, Australia
[10] St Vincents Hosp, Dept Cardiothorac Surg, Sydney, NSW, Australia
关键词
Cardiopulmonary resuscitation; CPR; Extracorporeal membrane oxygenation; ECMO; ECPR; Cardiac arrest; ELS; ECLS; AMERICAN-HEART-ASSOCIATION; LIFE-SUPPORT; MEMBRANE-OXYGENATION; SURVIVAL; HYPOTHERMIA; REPERFUSION; PREDICTORS; GUIDELINES; DURATION; OUTCOMES;
D O I
10.1016/j.ijcard.2016.12.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim: To describe the ECPR experience of two Australian ECMO centres, with regards to survival and neurological outcome, their predictors and complications. Methods: Retrospective observational study of prospectively collected data on all patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) at two academic ECMO referral centres in Sydney, Australia. Measurements and main results: Thirty-seven patients underwent ECPR, 25 (68%) were for in-hospital cardiac arrests. Median age was 54 (IQR 47-58), 27 (73%) were male. Initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 20 patients (54%), pulseless electrical activity (n= 14, 38%), and asystole (n= 3, 8%). 27 (73%) arrests were witnessed and 30 (81%) patients received bystander CPR. Median time from arrest to initiation of ECMO flow was 45min (IQR 30-70), and the median time on ECMO was 3 days (IQR 1-6). Angiography was performed in 54% of patients, and 27% required subsequent coronary intervention (stenting or balloon angioplasty 24%). A total of 13 patients (35%) survived to hospital discharge (IHCA 33% vs. OHCA 37%). All survivors were discharged with favourable neurological outcome (Cerebral Performance Category 1 or 2). Pre-ECMO lactate level was predictive of mortality OR 1.35 (1.06-1.73, p = 0.016). Conclusions: In selected patients with refractory cardiac arrest, ECPR may provide temporary support as a bridge to intervention or recovery. We report favourable survival and neurological outcomes in one third of patients and pre-ECMO lactate levels predictive of mortality. Further studies are required to determine optimum selection criteria for ECPR. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:131 / 136
页数:6
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