体外膜肺氧合辅助心肺复苏启动和终止的时间特征分析

The Analysis of time characteristics from extracorporeal cardiopulmonary resuscitation initiation to termination

目的调查分析体外膜肺氧合辅助心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)启动和终止的时间特征。方法回顾性分析南京医科大学第一附属医院体外生命支持中心2015年4月至2023年10月收治的ECPR患者的资料,以90 d存活/死亡、院内心脏骤停/院外心脏骤停(out-of-hospital/in-hospital cardiac arrest,IHCA/OHCA)比例、日间/夜晚时段启动、是否程序性终止进行分组,比较年龄、性别、查尔森合并症指数、院际联动、初始心律、ECPR初始血气pH和乳酸值、无灌流时间、心脏骤停至ECMO(extracorporeal membrane oxygenation)转流时间(CA-Pump On时间)、ECPR启动/终止和ECMO治疗时间、90 d存活率等的差异。结果200例ECPR患者纳入分析,心源性病因占70.5%,男性多于女性,90 d存活68例(34.0%),其中61例(89.7%)神经功能预后良好。90 d存活组的无灌流时间显著低于死亡组,ECPR初始血气pH值高、乳酸值低,且IHCA和初始可电击心律的比例高。OHCA组的无灌流时间显著高于IHCA组,ECPR初始血气pH值低、乳酸值高,77.4%为非程序性终止,90 d存活率16.1%。⑷各时间段均有ECPR启动,IHCA-ECPR随机启动,OHCA-ECPR凌晨启动少,启动时间对ECPR结局无明显影响。有75.5%的ECPR在日间时段终止ECMO,56.8%的死亡病例发生在ECPR后的3 d内,程序性终止组有19.0%的患者因综合因素死亡。结论对IHCA、初始可电击心律和无灌流时间短的患者实施ECPR具有潜在高获益。ECPR启动时间无规律且对结局无影响,死亡事件易发生在ECPR启动后的早期,ECPR终止时间多集中在日间工作时段,应加强全天候ECPR团队的建设。

Objective To investigate the time characteristics from extracorporeal cardiopulmonary resuscitation(ECPR)initiation to termination.Methods The data of ECPR patients in extracorporeal life support center of the First Affiliated Hospital of Nanjing Medical University from April 2015 to October 2023 were retrospectively analyzed.The patients were grouped by survival/death at 90 days,in-hospital/out-of-hospital cardiac arrest(IHCA/OHCA),daytime/evening initiation,and procedural/non-procedural termination.Data on age,sex,Charlson comorbidity index,interhospital transport,initial rhythm,ECPR initial blood gas pH and lactate value,no-flow time,time from cardiac arrest to extracorporeal membrane oxygenation(ECMO)initiation(CA-Pump On time),ECPR initiation/termination and ECMO treatment time,90-day survival rate and so on were analyzed.Results 200 ECPR patients were enrolled,the cardiogenic etiologies were accounted for 70.5%,more men than women,68(34.0%)patients survived at 90 days,of whom 61(89.7%)patients had good neurological outcomes.The 90-day survival group had a significantly lower of no-flow time,a higher proportion of IHCA and initial shockable heart rhythm,with a higher ECPR initial blood gas pH and a lower lactic acid value than those in the death group.3.The no flow time in OHCA group was significantly longer than that in IHCA group,with a lower ECPR initial blood gas pH and a higher lactic acid value,77.4%were nonprocedural termination and the 90-day survival rate was 16.1%.ECPR were initiated in all time periods,IHCA-ECPR initiated at random,OHCA-ECPR were rare in the early morning,and the initiation time had no significant effect on ECPR outcomes.There were 75.5%of ECPR terminated at the daytime,56.8%death cases were occurred within 3 days after ECPR,and 19.0%of patients in the procedural termination group died due to a combination of factors.Conclusions ECPR had a potentially high benefit for patients with IHCA,initial shockable rhythm,and a short no-flow time.The ECPR initiation time were irregular and had no effect on ECPR outcomes.Death events tend to occur in the early days after ECPR,and ECPR terminated is mostly during the daytime working hours.The construction of full-time ECPR team should be strengthened.