Clinical evaluation of extracorporeal cardiopulmonary resuscitation in adult sudden cardiac death
10.3760/cma.j.issn.1671-0282.2024.02.011
- VernacularTitle:体外膜肺氧合辅助心肺复苏治疗成人心脏性猝死的临床评价
- Author:
Huazhong ZHANG
1
;
Zhongman ZHANG
;
Yong MEI
;
Jinru LYU
;
Deliang HU
;
Feng SUN
;
Wei LI
;
Gang ZHANG
;
Xufeng CHEN
Author Information
1. 南京医科大学第一附属医院急诊中心，南京 210029
- Keywords:
Extracorporeal cardiopulmonary resuscitation;
Sudden cardiac death;
Retrospective analysis
- From:
Chinese Journal of Emergency Medicine
2024;33(2):204-209
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) on the treatment of sudden cardiac death (SCD).Methods:The data of 120 adults with SCD-ECPR in emergency department of the first affiliated hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), with/without acute myocardial infarction (AMI) and divided according to 60 min of the time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time). Age, sex, Charlson comorbidity index, IHCA/OHCA, initial rhythm, no-flow time, CA-Pump On time, ECMO evacuation success rate, 90-day survival rate, ECMO treatment time were analyzed.Results:①Total of 114 adult patients with SCD-ECPR were enrolled, and 45 (39.5%) patients survived at 90 days, of whom 40 (88.9%) patients had good neurological outcomes.②Age and no-flow time were significantly lower in the 90-day survival group than that in death group, and the proportion of IHCA and shockable initial rhythm was higher. ③The no flow time in IHCA group was significantly lower than that in OHCA group, and the 90-day survival rate was higher. ④OHCA and regional interhospital transport prolonged CA-Pump On time and reduced the 90-day survival rate. ⑤The AMI group was older with a higher Charlson comorbidity index, and the 90-day survival rate was significantly lower than that in non-AMI group.Conclusions:ECPR improves the prognosis of patients with SCD, there are high benefits in patients with long healthy life expectancy, IHCA, shockable initial rhythm, and short no flow time. The smooth life-saving chain of SCD-ECPR improves survival rate, by screening high benefit candidates in patients with OHCA, delayed initiation of ECPR or requiring interhospital transport, despite CA-Pump On time > 60 min, there is still survival potential.
