Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus extracorporeal cardiopulmonary resuscitation

被引:104
作者
Siao, Fu-Yuan [1 ,2 ]
Chiu, Chun-Chieh [1 ]
Chiu, Chun-Wen [1 ]
Chen, Ying-Chen [3 ]
Chen, Yao-Li [3 ]
Hsieh, Yung-Kun [3 ]
Lee, Chien-Hui [3 ]
Wu, Chang-Te [1 ]
Chou, Chu-Chung [1 ]
Yen, Hsu-Heng [4 ,5 ]
机构
[1] Changhua Christian Hosp, Dept Emergency Med, Changhua, Taiwan
[2] Changhua Christian Hosp, Dept Crit Care Med, Changhua, Taiwan
[3] Changhua Christian Hosp, Dept Cardiovasc Surg, Changhua, Taiwan
[4] Changhua Christian Hosp, Dept Internal Med, Changhua, Taiwan
[5] Chung Shan Med Univ, Coll Med, Taichung, Taiwan
关键词
Cardiac arrest; Refractory ventricular fibrillation; Cardiopulmonary resuscitation; Conventional cardiopulmonary resuscitation (C-CPR); Extracorporeal membrane oxygenation (ECMO); Extracorporeal cardiopulmonary resuscitation (E-CPR); MEMBRANE-OXYGENATION; LIFE-SUPPORT; ASSOCIATION; MANAGEMENT; AMIODARONE; RECOVERY; DURATION; SYSTEM; ADULTS;
D O I
10.1016/j.resuscitation.2015.04.016
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: Refractory ventricular fibrillation, resistant to conventional cardiopulmonary resuscitation (CPR), is a life threatening rhythm encountered in the emergency department. Although previous reports suggest the use of extracorporeal CPR can improve the clinical outcomes in patients with prolonged cardiac arrest, the effectiveness of this novel strategy for refractory ventricular fibrillation is not known. We aimed to compare the clinical outcomes of patients with refractory ventricular fibrillation managed with conventional CPR or extracorporeal CPR in our institution. Method: This is a retrospective chart review study from an emergency department in a tertiary referral medical center. We identified 209 patients presenting with cardiac arrest due to ventricular fibrillation between September 2011 and September 2013. Of these, 60 patients were enrolled with ventricular fibrillation refractory to resuscitation for more than 10 min. The clinical outcome of patients with ventricular fibrillation received either conventional CPR, including defibrillation, chest compression, and resuscitative medication (C-CPR, n = 40) or CPR plus extracorporeal CPR (E-CPR, n = 20) were compared. Results: The overall survival rate was 35%, and 18.3% of patients were discharged with good neurological function. The mean duration of CPR was longer in the E-CPR group than in the C-CPR group (69.90 +/- 49.6 min vs 34.3 +/- 17.7 min, p = 0.0001). Patients receiving E-CPR had significantly higher rates of sustained return of spontaneous circulation (95.0% vs 47.5%, p = 0.0009), and good neurological function at discharge (40.0% vs 7.5%, p = 0.0067). The survival rate in the E-CPR group was higher (50% vs 27.5%, p = 0.1512) at discharge and (50% vs 20%, p = 0.0998) at 1 year after discharge. Conclusions: The management of refractory ventricular fibrillation in the emergency department remains challenging, as evidenced by an overall survival rate of 35% in this study. Patients with refractory ventricular fibrillation receiving E-CPR had a trend toward higher survival rates and significantly improved neurological outcomes than those receiving C-CPR. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.
引用
收藏
页码:70 / 76
页数:7
相关论文
共 32 条
[1]  
[Anonymous], 2014, RESUSCITATION
[2]   Therapeutic strategy using extracorporeal life support, including appropriate indication, management, limitation and timing of switch to ventricular assist device in patients with acute myocardial infarction [J].
Aoyama, Naoyoshi ;
Imai, Hiroshi ;
Kurosawa, Toshiro ;
Fukuda, Naoto ;
Moriguchi, Masahiko ;
Nishinari, Makoto ;
Nishii, Mototsugu ;
Kono, Ken ;
Soma, Kazui ;
Izumi, Tohru .
JOURNAL OF ARTIFICIAL ORGANS, 2014, 17 (01) :33-41
[3]   Case 28-2013: A 52-Year-Old Man with Cardiac Arrest after an Acute Myocardial Infarction [J].
Brown, David F. M. ;
Jaffer, Farouc A. ;
Baker, Joshua N. ;
Gurol, M. Edip .
NEW ENGLAND JOURNAL OF MEDICINE, 2013, 369 (11) :1047-1054
[4]   Part 7: CPR Techniques and Devices 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [J].
Cave, Diana M. ;
Gazmuri, Raul J. ;
Otto, Charles W. ;
Nadkarni, Vinay M. ;
Cheng, Adam ;
Brooks, Steven C. ;
Daya, Mohamud ;
Sutton, Robert M. ;
Branson, Richard ;
Hazinski, Mary Fran .
CIRCULATION, 2010, 122 (18) :S720-S728
[5]  
Chang MY, 2005, J FORMOS MED ASSOC, V104, P639
[6]   Extracorporeal membrane oxygenation support can extend the duration of cardiopulmonary resuscitation [J].
Chen, Yih-Sharng ;
Yu, Hsi-Yu ;
Huang, Shu-Chien ;
Lin, Jou-Wei ;
Chi, Nai-Hsin ;
Wang, Chih-Hsien ;
Wang, Shoei-Shan ;
Lin, Fang-Yue ;
Ko, Wen-Je .
CRITICAL CARE MEDICINE, 2008, 36 (09) :2529-2535
[7]   Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis [J].
Chen, Yih-Sharng ;
Lin, Jou-Wei ;
Yu, Hsi-Yu ;
Ko, Wen-Je ;
Jerng, Jih-Shuin ;
Chang, Wei-Tien ;
Chen, Wen-Jone ;
Huang, Shu-Chien ;
Chi, Nai-Hsin ;
Wang, Chih-Hsien ;
Chen, Li-Chin ;
Tsai, Pi-Ru ;
Wang, Sheoi-Shen ;
Hwang, Juey-Jen ;
Lin, Fang-Yue .
LANCET, 2008, 372 (9638) :554-561
[8]  
Chiu CC, 2013, AM J EMERG MED, V31
[9]   Severe hyperkalemia with refractory ventricular fibrillation: successful resuscitation using extracorporeal membrane oxygenation [J].
Chiu, Chun-Chieh ;
Yen, Hsu-Heng ;
Chen, Yao-Li ;
Siao, Fu-Yuan .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2014, 32 (08) :943.e5-943.e6
[10]  
Chiu CW, 2013, AM J EMERG MED, V31