RESULTS: This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011-2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1-2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden\'s index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 109/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission.
CONCLUSIONS: Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.
结果:这项全国性的回顾性研究包括在丹麦接受ECPR治疗的226名难治性OHCA成人(2011-2020年)。评估ECPR启动后第一天的生物标志物。通过逻辑回归分析估计出院时良好的神经系统状况(脑功能类别1-2)的几率。使用Youden\的索引计算截止值。56名患者(25%)存活出院,51(91%)具有良好的神经状况。与有利的神经状态独立相关的因素是低流量时间<81分钟,入院白细胞≥12.8×109/L,入院乳酸<13.2mmol/L,碱性磷酸酶(ALP)<56(第1天)或<55U/L(第2天),和第1天肌酸激酶MB(CK-MB)<500ng/mL。选定的生物标志物(白细胞,C反应蛋白,和乳酸)是有利的神经状态的预测因子,比经典的OHCA变量(性别,年龄,低流量时间,目击逮捕,入院后单独电击节律)(P=0.001)。
结论:低灌注生物标志物(乳酸),炎症(白细胞),和器官损伤(ALP和CK-MB)与出院时的神经系统状况独立相关。低灌注和炎症(入院时)以及器官损伤(ECPR后第1天和第2天)的生物标志物可能有助于临床决定在难治性OHCA的情况下何时延长或终止ECPR。