Application of extracorporeal cardiopulmonary resuscitation in refractory in-hospital cardiac arrest in adults

doi:10.3877/cma.j.issn.1673-9450.2019.02.006

Abstract

Abstract:

Objective

To identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on survival and neurologic outcome in adults with refractory in-hospital cardiac arrest (IHCA).

Methods

All 74 adult patients who underwent ECPR for IHCA were enroued from July 2012 to December 2017 in Beiing Anzhen Hospital, Capital Medical University. Survival to discharge and cerebral performance category (CPC) scale were evaluated. The independent high-risk factors were determined using multivariate regression analysis models.

Results

Patients were discharged alive with favorable neurologic outcomes (CPC 1-2). Compared with patients in the SG group, the value of blood gas pH and extracellular residual alkaloids in the DG group were statistically lower (with P values below 0.05). The incidence of renal function failure requiring continuous renal replacement treatment (CRRT) and severe neurological complications were statistically higher in DG group patients. Multivariate regression analysis suggested that advanced age (age≥65 years), renal function failure requiring CRRT, and severe neurological complications were independent high-risk factors for hospital death.

Conclusions

ECMO can provide stable hemodynamic support to in-hospital cardiac arrest patients and save the lives of some patients. ECMO should be actively implanted when the cause of cardiac arrest is expected to be recoverable.

Key words: Extracorporeal membrane oxygenation, Cardiopulmonary resuscitation, Treatment outcome, In-hospital cardiac arrest

Yongchao Cui, Zhongtao Du, Chunjing Jiang, Jinhong Wang, Yu Jiang, Feng Yang, Zhichen Xing, Bo Xu, Dong Guo, Jialin Xing, Na Miao, Yanyan Zhao, Xing Hao, Hong Wang, Xiaotong Hou. Application of extracorporeal cardiopulmonary resuscitation in refractory in-hospital cardiac arrest in adults[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2019, 14(02): 108-112.

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URL: https://zhssyxfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1673-9450.2019.02.006

https://zhssyxfzz.cma-cmc.com.cn/EN/Y2019/V14/I02/108

Figures/Tables 4

References 15

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项目		SG组(n＝23)	DG组(n＝51)	P值
年龄(岁)		42.21±7.82	56.52±8.60	0.02
性别构成(男/女)		17/6	39/12	0.81
体表面积(m²)		1.79±0.22	1.71±0.13	0.86
吸烟史(例)		11	27	0.69
合并疾病[例(%)]		?	?	?
?	高血压	12(52.17)	27(52.94)	0.95
?	高脂血症	4(17.39)	9(17.64)	0.98
?	冠状动脉粥样硬化性心脏病	19(82.60)	35(68.63)	0.21
?	长期慢性阻塞性肺部疾病	0(0)	1(1.96)	0.50
?	急性暴发性重症心肌炎	1 (4.35)	0 (0)	0.14
?	产后心肌病	0 (0)	1 (1.96)	0.50
住院期间相关操作[例(%)]		?	?	?
?	冠状动脉搭桥术	15(65.22)	29(56.86)	0.50
?	瓣膜置换或成形术	1(4.35)	6(11.76)	0.32
?	瓣膜置换或成形＋冠状动脉搭桥术	4(17.39)	5(9.80)	0.36
?	心房颤动射频消融术	0(0)	1(1.96)	0.50
?	双腔起搏器置入术	1(4.35)	1(1.96)	0.56
?	阑尾炎切除术	0(0)	1(1.96)	0.50
?	冠状动脉介入术	1(4.35)	7(13.73)	0.23

项目		SG组(n＝23)	DG组(n＝51)	P值
年龄(岁)		42.21±7.82	56.52±8.60	0.02
性别构成(男/女)		17/6	39/12	0.81
体表面积(m²)		1.79±0.22	1.71±0.13	0.86
吸烟史(例)		11	27	0.69
合并疾病[例(%)]		?	?	?
?	高血压	12(52.17)	27(52.94)	0.95
?	高脂血症	4(17.39)	9(17.64)	0.98
?	冠状动脉粥样硬化性心脏病	19(82.60)	35(68.63)	0.21
?	长期慢性阻塞性肺部疾病	0(0)	1(1.96)	0.50
?	急性暴发性重症心肌炎	1 (4.35)	0 (0)	0.14
?	产后心肌病	0 (0)	1 (1.96)	0.50
住院期间相关操作[例(%)]		?	?	?
?	冠状动脉搭桥术	15(65.22)	29(56.86)	0.50
?	瓣膜置换或成形术	1(4.35)	6(11.76)	0.32
?	瓣膜置换或成形＋冠状动脉搭桥术	4(17.39)	5(9.80)	0.36
?	心房颤动射频消融术	0(0)	1(1.96)	0.50
?	双腔起搏器置入术	1(4.35)	1(1.96)	0.56
?	阑尾炎切除术	0(0)	1(1.96)	0.50
?	冠状动脉介入术	1(4.35)	7(13.73)	0.23

项目		SG组(n＝23)	DG组(n＝51)	P值
时间间隔		?	?	?
?	首次除颤时间(min)	5.21±1.50	6.82±2.43	0.46
?	开始心肺复苏到建立ECMO辅助(min)	28.70±10.33	46.94±13.50	0.02
心肺复苏发生地点[例(%)]		?	?	?
?	急诊抢救室	1(4.34)	0(0)	0.14
?	心内科导管室	3(13.04)	7(13.73)	0.94
?	心脏术后监护室	12(52.17)	27(52.94)	0.95
?	手术室	5(21.73)	13(25.49)	0.80
?	普通病房	2(8.70)	4(7.84)	0.92
ECPR时血气结果		?	?	?
?	pH值(±s)	7.18±0.08	7.05±0.16	0.00
?	PCO₂(mmHg, ±s)	33.12±8.50	39.00±11.34	0.15
?	PO₂(mmHg)	140(68, 380)	128(55, 188)	0.15
?	细胞外剩余碱( ±s)	－4.92±3.10	－13.84±4.41	0.01
?	乳酸浓度(mmol/L, ±s)	14.83±2.71	16.13±3.82	0.68

项目		SG组(n＝23)	DG组(n＝51)	P值
时间间隔		?	?	?
?	首次除颤时间(min)	5.21±1.50	6.82±2.43	0.46
?	开始心肺复苏到建立ECMO辅助(min)	28.70±10.33	46.94±13.50	0.02
心肺复苏发生地点[例(%)]		?	?	?
?	急诊抢救室	1(4.34)	0(0)	0.14
?	心内科导管室	3(13.04)	7(13.73)	0.94
?	心脏术后监护室	12(52.17)	27(52.94)	0.95
?	手术室	5(21.73)	13(25.49)	0.80
?	普通病房	2(8.70)	4(7.84)	0.92
ECPR时血气结果		?	?	?
?	pH值(±s)	7.18±0.08	7.05±0.16	0.00
?	PCO₂(mmHg, ±s)	33.12±8.50	39.00±11.34	0.15
?	PO₂(mmHg)	140(68, 380)	128(55, 188)	0.15
?	细胞外剩余碱( ±s)	－4.92±3.10	－13.84±4.41	0.01
?	乳酸浓度(mmol/L, ±s)	14.83±2.71	16.13±3.82	0.68

项目		SG组(n＝23)	DG组(n＝51)	P值
ECMO辅助时间(h)		115.61±9.60	104.32±10.62	0.19
并发症[例(%)]		?	?	?
?	肾脏功能衰竭需CRRT治疗	3(13.04)	32(62.75)	<0.01
?	感染	4(17.39)	14(27.45)	0.35
?	出血	4(17.39)	12(23.53)	0.56
?	严重下肢缺血	1(4.34)	3(5.88)	0.79
?	严重神经系统并发症	0(0)	16(31.37)	0.00
血制品输入量		?	?	?
?	悬浮红细胞(u)	20.22±4.13	23.67±3.61	0.27
?	新鲜冰冻血浆(mL)	1800.83±269.07	1959.01±205.32	0.49
?	机采血小板(u)	4.03±1.80	5.01±0.72	0.18
ICU停留时间(h)		158 (92, 204)	100 (38, 189)	0.00
住院时间(d)		21.82±5.23	11.24±3.80	<0.01

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