体外心肺复苏对成人心跳骤停患者预后影响因素的多中心回顾性研究

A Multicenter Retrospective Study of the Prognostic Factors of Extracorporeal Cardiopulmonary Resuscitation in Adult Patients with Cardiac Arrest

摘要: 目的：通过回顾性分析中国成人ECPR (External Cardiopulmonary Resuscitation)支持的数据，探索影响成人ECPR患者生存的危险因素。方法：回顾分析2016年1月至2020年6月中国成人ECMO (Extracorporeal Membrane Oxygenation)数据库369例ECPR支持的相关数据。根据临床结局将患者分为存活组及死亡组并进行分析比较。死亡患者265例(71.8%)，存活患者104例(28.2%)，男性276人(74.8%)，女性93人(25.2%)。观察指标：基线资料、复苏情况、住院期间情况等。结果：基线资料中住院时间及住ICU (Intensive Care Unit)时间存在差异，死亡组的时间明显低于存活组(p < 0.000)。既往病史两组之间无差异。CPR (Cardio Pulmonary Resuscitation)至ECMO时间，CPR至ECMO时间，ECMO团队接到求助电话到启动ECMO时间，死亡组高于存活组(p < 0.05)。存活组恢复自主循环，ECMO辅助前除颤的患者比例更高(p < 0.000)。神经系统并发症、肢体并发症，存活组低于死亡组(p < 0.05)。随着ECMO辅助时间延长，感染风险存活组较死亡组明显增加(p < 0.000)。存活组内环境明显稳定于死亡组(p < 0.05)。结论：ECMO辅助前及辅助期间的乳酸水平，心跳骤停到ECMO启动的时间可作为参考指标，辅助判断成年ECPR患者的预后。把握ECPR的时机，缩短恢复自主循环时间，加强抢救团队训练及多学科的合作，加强ECMO期间的患者管理，减少并发症是提高患者疗效的关键。

Abstract: Objective: To explore the risk factors for survival of adult ECPR patients by retrospective analysis of ECPR (external cardiopulmonary resuscitation) support data in China. Methods: The data of 369 cases of ECPR in Chinese adult ECMO database from January 2016 to June 2020 were retrospectively analyzed. According to the clinical outcome, the patients were divided into survival group and death group, then, we analyzed and compared it. 265 patients (71.8%) died, 104 patients (28.2%) survived, 276 males (74.8%) and 93 females (25.2%). The outcome measures: baseline data, resuscitation, duration of hospitalization and so on. Results: There were differences in length of hospital stay and length of ICU (Intensive Care Unit) stay in baseline data, and the length of hospital stay in the death group was significantly lower than that in the survival group (p < 0.000). Past medical history did not differ between the two groups. For time from CPR to ECMO, time from CPR to ECMO, time from ECMO team to ECMO initiation, death group was higher than survival group (p < 0.05). A higher proportion of patients in the survival group resumed autonomic circulation with ECMO-assisted pre-defibrillation (p < 0.000). Neurological complications and limb complications were lower in the survival group than in the death group (p < 0.05). With the prolonged duration of ECMO assistance, the risk of infection increased significantly in the survival group compared with the death group (p < 0.000). The homeostasis in survival group was more stable than that in death group (p < 0.05). Conclusions: Lactic acid level before and during ECMO treatment and the time from cardiac arrest to ECMO initiation can be used as reference indexes to help judge the prognosis of adult ECPR patients. Grasping the opportunity of ECPR, shortening the recovery time of spontaneous circulation, strengthening the training of rescue team and multi-disciplinary cooperation, strengthening the patient management during ECMO, and reducing complications are the key to improving the curative effect of patients.