心搏骤停后接受静脉动脉体外膜肺氧合支持患者的神经系统并发症分析

Analysis of neurological complications in patients receiving venous-arterial extracorporeal membrane oxygenation support after cardiac arrest

目的分析接受静脉动脉体外膜肺氧合支持的心搏骤停患者出现神经系统并发症的流行病学、临床特征和危险因素。方法回顾性分析2012年6月~2019年6月期间我科收治的22例因心搏骤停而接受静脉动脉体外膜肺氧合(V-A ECMO)辅助的成年患者(>18岁),分为有神经系统并发症组及无神经系统并发症组,并对比两组患者基本资料、与CPR和ECMO相关的资料等数据的差异性。结果22例ECPR患者中,63.6%出现神经系统并发症,其中位年龄、接受主动脉内球囊反搏辅助的比例、连续性肾脏替代治疗的比例及ECMO辅助前的中位pH值和血肌酐中位含量均明显高于无神经系统并发症组。有神经系统并发症组患者的自发循环恢复(ROSC)中位时间、持续无搏动灌注超过12 h的比例、ECMO持续时间、深镇静持续时间、ECMO运行24 h的气道内峰压、脓毒症发生比例及28 d病死率等均明显高于无神经系统并发症组(P<0.05)。此外,多因素回归分析发现,年龄、CA到ROSC时间、持续无搏动灌注超过12 h、深镇静持续时间是ECPR患者发生神经系统并发症的独立危险因素。结论心搏骤停后接受ECPR的患者出现神经系统并发症的发生率高,与不良结局密切相关。年龄、深镇静持续时间、CA到ROSC时间、持续无搏动灌注超过12 h是ECPR患者发生神经系统并发症的独立危险因素。

Objective To analyze the epidemiology,clinical features,and risk factors of neurological complications in cardiac arrest patients receiving venous-arterial extracorporeal membrane oxygenation support.Methods A total of 22 adult patients(>18 years old)who received venous-arterial extracorporeal membrane oxygenation(V-A ECMO)due to cardiac arrest in our department from June 2012 to June 2019 were retrospectively analyzed.They were divided into a group with neurological complications and a group without neurological complications.The differences in basic data,CPR and ECMO-related data,and other data of the two groups were compared.Results Among 22 ECPR patients,63.6%developed neurological complications.The median age,the proportion of receiving intra-aortic balloon counterpulsation,the proportion of continuous renal replacement therapy,and the median pH and the median content of blood creatinine before ECMO was significantly higher than that of the control group.The median time of the return of spontaneous circulation(ROSC),the proportion of continuous non-pulsatile perfusion for more than 12 hours,the duration of ECMO,the duration of deep sedation,the peak airway pressure within 24 hours of ECMO operation,and the incidence rate of sepsis and the 28-day mortality rate in patients with neurological complications were significantly higher than those in the control group(P<0.05).In addition,multivariate regression analysis found that age,the time from cardiac arrest to ROSC,continuous non-beating perfusion for more than 12 hours,and the duration of deep sedation are independent risk factors for neurological complications in ECPR patients.Conclusion Patients who received ECPR after cardiac arrest have a high incidence of neurological complications,which are closely related to adverse outcomes.Age,duration of deep sedation,time from CA to ROSC,and continuous non-pulsatile perfusion for more than 12 hours are independent risk factors for neurological complications in ECPR patients.