目的: 分析院内心脏骤停体外心肺复苏（extracorporeal cardiopulmonary resuscitation,ECPR）患者的临床特征,探索导致患者院内死亡的主要危险因素。方法: 回顾性分析2020年1月—2022年12月在郑州大学第一附属医院发生院内心脏骤停接受ECPR的115例患者的临床资料。根据患者临床结局分为存活出院组和院内死亡组,比较两组临床资料的差异,探讨导致患者院内死亡及预后不良的相关危险因素。采用Cox多因素回归分析探究各变量对患者院内死亡的影响。结果: 本研究回顾性分析了本中心近3年的共115例ECPR患者,依据纳排标准后最终纳入了74例,其中存活出院率36.5%。与存活出院组相比,院内死亡组在ECMO运行时间及患者住院时间更短、ECMO稳定运行后血气中乳酸第24 h更高,而第24 h乳酸清除率更低、CRRT治疗、肢体并发症及心脏并发症人数更多、ECPR前恢复自主循环更少、SOFA评分及APACHE-Ⅱ评分更高、SAVE评分更低,差异均有统计学意义。其中ECMO心脏并发症、ECMO运行时间、ECMO后第24 h的乳酸清除率是导致ECPR患者预后不良的危险因素。结论: ECMO心脏并发症、ECMO运行时间、ECMO后第24 h的乳酸清除率是院内ECPR患者死亡的独立危险因素。
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.
关键词
院内心脏骤停 /
体外膜肺氧合 /
体外心肺复苏 /
危险因素
Key words
In-hospital cardiac arrest /
extracorporeal membrane oxygenation /
extracorporeal cardiopulmonary resuscitation /
risk factors
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参考文献
[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.
基金
湖南省急危重症临床医学研究中心（2021SK4011）; 湖南省自然科学基金“基于急性中毒精准快速检测和临床验证关键技术研究”（2024JJ9160）
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