体外心肺复苏在成人心脏骤停中的应用

Application of extracorporeal cardiopulmonary resuscitation in adult patients with cardiac arrest

目的总结体外心肺复苏(ECPR)在成人心脏骤停患者循环辅助中的临床经验。方法收集2019-04~2020-12在该院EICU收住的进行ECPR救治的心脏骤停患者26例,回顾性分析患者的病历资料,对比生存组与死亡组的临床资料、实验室检查结果及各参数指标等。结果26例患者中有9例成功从体外膜肺氧合(ECMO)撤机;6例存活出院,均为院内心脏骤停(IHCA)患者,20例死亡。生存组的起始乳酸值及ECPR后6 h、12 h的乳酸值均低于死亡组,ECPR后6 h、12 h的平均动脉压均高于死亡组,ECPR后6 h、12 h的左室流出道速度时间积分均高于死亡组,差异有统计学意义(P<0.05)。结论ECMO可以为传统心肺复苏(CCPR)失败的患者提供紧急的体外循环辅助,挽救部分患者的生命。

Objective To summarize the clinical experience of extracorporeal cardiopulmonary resuscitation(ECPR)as circulatory assist in adult patients with cardiac arrest.Methods A total of 26 cardiac arrest patients who were admitted to the Emergency Intensive Care Unit(EICU)of the People′s Hospital of Guigang for ECPR treatment from April 2019 to December 2020 were collected.A retrospective analysis was performed on the patients′medical records,and the clinical data,laboratory examination results,and various parameters and indicators were compared between the survival group and the death group.Results Among the 26 patients,9 cases were successfully weaned from extracorporeal membrane oxygenation(ECMO)and 6 cases survived to hospital discharge.All the survivors were the patients with in-hospital cardiac arrest(IHCA).Twenty cases died.The initial lactate value and the lactate values 6 and 12 hours after ECPR in the survival group were lower than those in the death group.The values of mean arterial pressure 6 and 12 hours after ECPR in the survival group were higher than those in the death group.The velocity time integral of the left ventricular outflow tract 6 and 12 hours after ECPR in the survival group was higher than that in the death group.There were significantly differences in the above indicators between the two groups(P<0.05).ConclusionECMO can save the lives of some patients who have failed conventional cardiopulmonary resuscitation(CCPR)by providing emergency cardiopulmonary bypass assistance.