40例体外膜肺氧合辅助心肺复苏治疗成人院外心脏骤停的回顾性分析  

Retrospective analysis of extracorporeal cardiopulmonary resuscitation in 40 out-of-hospital cardiac arrest adults

作　　者：张华忠[1] 梅勇[1] 吕金如[1] 胡德亮[1] 孙峰 李伟[1] 张刚[1] 张劲松[1] 陈旭锋[1] Zhang Huazhong;Mei Yong;Lv Jinru;Hu Deliang;Sun Feng;Li Wei;Zhang Gang;Zhang Jinsong;Chen Xufeng(Emergency Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029,China)

机构地区：[1]南京医科大学第一附属医院急诊中心,南京210029

出　　处：《中华急诊医学杂志》2022年第12期1618-1622,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省“六个一工程”拔尖人才(LGY20190688);国家自然科学基金(82072159);临床重点专科项目[苏财政(2020)155号];专科能力建设项目[苏财政(2021)79号]。

摘　　要：目的总结体外膜肺氧合辅助心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)对于成人院外心脏骤停(out-of-hospital cardiac arrest,OHCA)的经验和效果。方法回顾南京医科大学第一附属医院急诊中心2015年4月至2022年4月40例成人OHCA-ECPR的资料,以出院存活/院内死亡、有/无旁观者复苏、有/无院际联动分组,比较年龄、性别、查尔森合并症指数、初始心律、无血流时间、心脏骤停至ECMO(extracorporeal membrane oxygenation)转流时间(CA-Pump On时间)、ECMO撤离成功率、存活率、ECMO时间、死亡时间、住院时间的差异。结果①40例OHCA-ECPR患者,出院存活9人(22.5%),其中7人(77.8%)神经功能预后良好。②存活组的无血流时间显著低于死亡组,且初始可电击心律的比例高。③旁观者复苏显著缩短无血流时间。④区域内OHCA-ECPR院际联动延长CA-Pump On时间,并不影响患者预后。结论ECPR改善OHCA患者的预后,旁观者复苏缩短无血流时间,无血流时间短及初始可电击心律的OHCA患者ECPR的有效性显著。推荐区域内ECPR的院际联动,使更多的OHCA患者获益。Objective To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation(ECPR)in the treatment of out-of-hospital cardiac arrest(OHCA)in adults.Methods The data of 40 adults with OHCA-ECPR in Emergency Department of the First Affi liated Hospital of Nanjing Medical University from April 2015 to April 2022 were retrospectively analyzed.The patients were grouped by discharge survival/in-hospital death,with/without bystander resuscitation,and with/without interhospital transport.Age,sex,Charlson comorbidity index,initial rhythm,no-fl ow time,time from cardiac arrest to extracorporeal membrane oxygenation(ECMO)initiation(CA-Pump On time),ECMO evacuation success rate,survival rate,ECMO treatment time,time-to-death,and length of hospital stay were analyzed.Results①Among the 40 patients with OHCA-ECPR,9 patients(22.5%)survived upon discharge,7(77.8%)of whom had good neurological outcomes.②The no-fl ow time in the survival group was signifi cantly shorter than that in the death group,and the proportion of shockable initial rhythm was higher.③Bystander resuscitation greatly shortened the no-flow time.④The regional OHCA-ECPR interhospital transport extended the CA-Pump On time,without affecting patients’prognosis.Conclusions ECPR improves the prognosis of patients with OHCA.Bystander resuscitation greatly shortens the no-fl ow time.ECPR is signifi cantly effective in patients with short no-fl ow time and shockable initial rhythm.Regional interhospital transport ECPR is recommended to benefi t more patients with OHCA.

关 键 词：体外膜肺氧合辅助心肺复苏 院外心脏骤停 回顾性分析 

分 类 号：R459.7[医药卫生—急诊医学]