PDF(Pubmed)
Abstract：
Extracorporeal cardiopulmonary resuscitation (eCPR) is emerging as an effective, lifesaving resuscitation strategy for select patients with prolonged or refractory cardiac arrest. Currently, a paucity of evidence-based recommendations is available to guide clinical management of eCPR patients. Despite promising results from initial clinical trials, neurological injury remains a significant cause of morbidity and mortality. Neuropathology associated with utilization of an extracorporeal circuit may interact significantly with the consequences of a prolonged low-flow state that typically precedes eCPR. In this narrative review, we explore current gaps in knowledge about cerebral perfusion over the course of cardiac arrest and resuscitation with a focus on patients treated with eCPR. We found no studies which investigated regional cerebral blood flow or cerebral autoregulation in human cohorts specific to eCPR. Studies which assessed cerebral perfusion in clinical eCPR were small and limited to near-infrared spectroscopy. Furthermore, no studies prospectively or retrospectively evaluated the relationship between epinephrine and neurological outcomes in eCPR patients. In summary, the field currently lacks a comprehensive understanding of how regional cerebral perfusion and cerebral autoregulation are temporally modified by factors such as pre-eCPR low-flow duration, vasopressors, and circuit flow rate. Elucidating these critical relationships may inform future strategies aimed at improving neurological outcomes in patients treated with lifesaving eCPR.
摘要：
体外心肺复苏(eCPR)作为一种有效的,选择长期或难治性心脏骤停患者的挽救生命的复苏策略。目前,目前缺乏以证据为基础的建议来指导eCPR患者的临床管理.尽管最初的临床试验取得了有希望的结果，神经损伤仍然是发病率和死亡率的重要原因。与体外回路的利用相关的神经病理学可能与通常在eCPR之前的延长的低流量状态的后果显著地相互作用。在这篇叙述性评论中，我们探讨了目前在心脏骤停和复苏过程中脑灌注知识方面的差距,重点关注接受eCPR治疗的患者.我们没有发现研究特定于eCPR的人类队列中的局部脑血流量或脑自动调节的研究。在临床eCPR中评估脑灌注的研究很小，并且仅限于近红外光谱。此外，没有前瞻性或回顾性研究评估肾上腺素与eCPR患者神经系统结局之间的关系.总之,该领域目前缺乏对局部脑灌注和脑自动调节如何在时间上受到诸如eCPR前低流量持续时间等因素的影响的全面了解。血管升压药,和回路流量。阐明这些关键关系可能会为未来的策略提供信息，旨在改善接受挽救生命的eCPR治疗的患者的神经系统预后。
