Risk factors of death in ECPR patients with in-hospital cardiac arrest
HU Conglong1, HUANG Mingjun2, YIN Liyi1, ZHAN Jin3, LIU Yiqun1, CAO Yan1, HAN Xiaotong1
1. Department of Emergency Medicine, Clinical Research Center For Emergency and Critical Care In Hunan Province, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital / The First Affiliated Hospital of Hunan Normal University, Changsha 410005, China; 2. Department of extracorporeal support center,the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China; 3. Department of Emergency Intensive Care Unit, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
Abstract：Objective To analyze the clinical characteristics of in-hospital cardiac arrest (IHCA) patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and explore the main risk factors leading to in-hospital mortality. Methods A retrospective analysis was conducted on the clinical data of 115 IHCA patients who received ECPR at the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022. Patients were divided into a survival discharge group and an in-hospital mortality group based on clinical outcomes. The differences in clinical data between the two groups were compared, and relevant risk factors for in-hospital mortality and poor prognosis were investigated. Cox multivariate regression analysis was used to explore the impact of various variables on in-hospital mortality. Results This study retrospectively analyzed 115 ECPR patients over the past three years, ultimately including 74 patients based on inclusion and exclusion criteria, with a survival discharge rate of 36.5%. Compared to the survival discharge group, the in-hospital mortality group had shorter ECMO run time and hospital stay, higher lactate levels at 24 hours post-ECMO stabilization, lower 24-hour lactate clearance rate, more CRRT treatments, more limb and cardiac complications, less return of spontaneous circulation before ECPR, higher SOFA and APACHE II scores, and lower SAVE scores, with statistically significant differences. ECMO cardiac complications, ECMO run time, and 24-hour lactate clearance rate post-ECMO were identified as risk factors for poor prognosis in ECPR patients. Conclusion ECMO cardiac complications, ECMO run time, and 24-hour lactate clearance rate post-ECMO are independent risk factors for in-hospital mortality in ECPR patients.
[1] LI Y, HE L, HUANG X, et al.Genetic Lineage Tracing of Nonmyocyte Population by Dual Recombinases[J]. Circulation, 138(8): 793-805. [2] MOZAFFARIAN D B, BENJAMIN E J, GO A S, et al.Heart disease and stroke statistics--2015 update: areport from the American Heart Association[J]. Circulation, 2015, 131(4): e29-e322. [3] VIRANI S S, ALONSO A, BENJAMIN E J, et al.Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association[J]. Circulation, 2020, 141(9): e139-e596. [4] PANCHAL AR, BARTOS JA, CABAÑAS JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation, 2020, 142(16_suppl_2): S366-S468. [5] 中华医学会急诊医学分会复苏学组, 中国医药教育协会急诊专业委员会. 成人体外心肺复苏专家共识更新 (2023版)[J]. 中华急诊医学杂志, 2023, 32(3): 298-304. [6] RICHARDSON ASC, TONNA JE, NANJAYYA V, et al.Extracorporeal Cardiopulmonary Resuscitation in Adults. Interim Guideline Consensus Statement From the Extracorporeal Life Support Organization[J]. ASAIO J, 2021, 67(3): 221-228. [7] PRONDZINSKY R, WERDAN K.Extracorporeal life support during cardiac arrest and cardiogenic shock-how good is the evidence really?[J]. Ann Transl Med, 2017, 5(3): 58. [8] LAMHAUT L, HUTIN A, PUYMIRAT E, et al.A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strate-gy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis[J]. Resuscitation, 2017, 117: 109-117. [9] SAKAMOTO T, MORIMURA N, NAGAO K, et al.Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: A prospective observational study[J]. Resuscitation, 2014, 85(6): 762-768. [10] C. BASÍLIO, FONTOURA A, FERNANDES J, et al. Cardiac Tamponade Complicating Extracorporeal Membrane Oxygenation: A Single-Centre Experience[J]. Heart Lung Circ, 2021, 30(10): 1540-1544. [11] Smith M, Vukomanovic A, Brodie D, et al.Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an analysis of the Extracorporeal Life Support Organization (ELSO) registry[J]. Crit Care, 2017, 21(1): 45. [12] MUNGAN İ, KAZANCI D, BEKTAŞ Ş, et al.Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study[J]. BMC Anesthesiol, 2018, 18(1): 152. [13] NG WT, LING L, JOYNT GM, et al.An audit of mortality by using ECMO specific scores and APACHE II scoring system in patients receiving extracorporeal membrane oxygenation in a tertiary intensive care unit in Hong Kong[J]. J Thorac Dis, 2019, 11(2): 445. [14] KAWASHIMA T, UEHARA H, MIYAGI N, et al.Impact of first documented rhythm on cost-effectiveness of extracorporeal cardiopulmonary resuscitation[J]. Resuscitation, 2019, 140: 74-80. [15] BARTOS J A, GRUNAU B, CARLSON C, et al.Improved Survival With Extracorporeal Cardiopulmonary Resuscitation Despite Progressive Metabolic Derangement Associated With Prolonged Resuscitation[J]. Circulation, 2020, 141(11): 877-886. [16] FRIEDRICHSON B, MUTLAK H, ZACHAROWSKI K, et al.Insight into ECMO, Mortality and ARDS: A Nationwide Analysis of 45, 647 ECMO Runs[J]. Crit Care, 2021, 25(1): 38.
2024, Vol. 21 
