Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

被引:12
作者
Siao, Fu-Yuan [3 ,4 ,5 ]
Chiu, Chun-Wen [3 ]
Chiu, Chun-Chieh [3 ]
Chang, Yu-Jun [6 ]
Chen, Ying-Chen [7 ]
Chen, Yao-Li [7 ]
Hsieh, Yung-Kun [7 ]
Chou, Chu-Chung [3 ]
Yen, Hsu-Hen [1 ,2 ]
机构
[1] Changhua Christian Hosp, Dept Internal Med, Changhua, Taiwan
[2] Chung Shan Med Univ, Coll Med, Taichung, Taiwan
[3] Changhua Christian Hosp, Dept Emergency Med, Changhua, Taiwan
[4] Changhua Christian Hosp, Dept Crit Care Med, Changhua, Taiwan
[5] Chung Yuan Christian Univ, Dept Mech Engn, Taoyuan, Taiwan
[6] Changhua Christian Hosp, Epidemiol & Biostat Ctr, Changhua, Taiwan
[7] Changhua Christian Hosp, Dept Cardiovasc Surg, Changhua, Taiwan
关键词
Refractory cardiac arrest; Out-of-hospital cardiac arrest; In-hospital cardiac arrest; Emergency department cardiac arrest; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; CONVENTIONAL CARDIOPULMONARY-RESUSCITATION; LOW-FLOW TIME; LIFE-SUPPORT; EMERGENCY-DEPARTMENT; VENTRICULAR-FIBRILLATION; ECMO; SURVIVAL; SCORE; MORTALITY; LACTATE;
D O I
10.1186/s13049-020-00753-6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution. Methods This is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model. Results The overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flowTime, cardiac arrestLocation, and initial cardiac arrestRhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%,p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%,p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%,p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%,p = 0.0003) than the medium-risk and high-risk groups. Conclusions Patients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.
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页数:10
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