Abstract：
OBJECTIVE: In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.
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.
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.
摘要：
目的：在难治性院外心脏骤停（OHCA）伴长期全身缺血，即使在体外心肺复苏（ECPR）建立循环后，全球组织损伤仍在继续。我们旨在研究反映灌注不足的生物标志物的作用，炎症,ECPR治疗难治性OHCA患者的预后和器官损伤。
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。
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。
