Abstract：
OBJECTIVE: The incidence of out-of-hospital cardiac arrest (OHCA) is high. Though extracorporeal cardiopulmonary resuscitation (ECPR) has been considered a potential treatment for refractory cardiac arrest after failure of conventional cardiopulmonary resuscitation (CCPR), the benefit of ECPR in refractory OHCA remains uncertain.
METHODS: In this retrospective cohort study, we included patients with refractory OHCA who visited the Emergency Department of the Aerospace Center Hospital between January 2018 and April 2023. We divided the patients into the ECPR Group and the CCPR Group. The primary endpoint of the study was the neurological function of the patients in both groups 3 months after the cardiac arrest. We used propensity score matching to reduce selection bias and identified factors associated with good neurological function when OHCA was treated with ECPR by performing univariate and multivariate correlation analyses on surviving patients with good neurological function in the ECPR group.
RESULTS: During the study period, we enrolled 133 patients, consisting of 33 in the ECPR group and 100 in the CCPR group. The survival rate of patients with good neurological function at discharge was 18.2% (6/33 cases) in the ECPR group and 9% (9/100 cases) in the CCPR group, p = .20. Three months after discharge, the survival rate of patients with good neurological function was 15.2% (5/33 cases) in the ECPR group and 8% (8/100 cases) in the CCPR group, p = .31. Using propensity score matching, we identified 22 pairs of patients for further analysis. Among these, 3 months after discharge, the survival rate of patients with good neurological function was 13.6% (3/22 cases) in the ECPR group and 4.5% (1/22 cases) in the CCPR group, p = .61, and the survival rate at discharge was 18.2% (4/22 cases) in the ECPR group and 4.5% (1/22 cases) in the CCPR group, p = .34. The univariate analysis of patients with good neurological function in the ECPR group showed that time without perfusion, hypoperfusion time, and PCI treatment were associated factors affecting the prognosis of neurological function in patients, while multivariate analysis showed that hypoperfusion time was independently associated with good neurological function, with an OR (95% CI) of 1.06 (1.00-1.14) and p = .05.
CONCLUSIONS: Our findings suggested that ECPR failed to significantly improve neurological outcome in patients with refractory OHCA; however, the small sample size in this study may be insufficient to detect clinically relevant differences. In addition, hypoperfusion time may be a key predictive factor in identifying candidates for ECPR.
METHODS: In this retrospective cohort study, we included patients with refractory OHCA who visited the Emergency Department of the Aerospace Center Hospital between January 2018 and April 2023. We divided the patients into the ECPR Group and the CCPR Group. The primary endpoint of the study was the neurological function of the patients in both groups 3 months after the cardiac arrest. We used propensity score matching to reduce selection bias and identified factors associated with good neurological function when OHCA was treated with ECPR by performing univariate and multivariate correlation analyses on surviving patients with good neurological function in the ECPR group.
RESULTS: During the study period, we enrolled 133 patients, consisting of 33 in the ECPR group and 100 in the CCPR group. The survival rate of patients with good neurological function at discharge was 18.2% (6/33 cases) in the ECPR group and 9% (9/100 cases) in the CCPR group, p = .20. Three months after discharge, the survival rate of patients with good neurological function was 15.2% (5/33 cases) in the ECPR group and 8% (8/100 cases) in the CCPR group, p = .31. Using propensity score matching, we identified 22 pairs of patients for further analysis. Among these, 3 months after discharge, the survival rate of patients with good neurological function was 13.6% (3/22 cases) in the ECPR group and 4.5% (1/22 cases) in the CCPR group, p = .61, and the survival rate at discharge was 18.2% (4/22 cases) in the ECPR group and 4.5% (1/22 cases) in the CCPR group, p = .34. The univariate analysis of patients with good neurological function in the ECPR group showed that time without perfusion, hypoperfusion time, and PCI treatment were associated factors affecting the prognosis of neurological function in patients, while multivariate analysis showed that hypoperfusion time was independently associated with good neurological function, with an OR (95% CI) of 1.06 (1.00-1.14) and p = .05.
CONCLUSIONS: Our findings suggested that ECPR failed to significantly improve neurological outcome in patients with refractory OHCA; however, the small sample size in this study may be insufficient to detect clinically relevant differences. In addition, hypoperfusion time may be a key predictive factor in identifying candidates for ECPR.
摘要：
目的：院外心脏骤停（OHCA）的发生率很高。尽管体外心肺复苏（ECPR）已被认为是常规心肺复苏（CCPR）失败后难治性心脏骤停的潜在治疗方法，ECPR在难治性OHCA中的获益仍不确定.
方法：在这项回顾性队列研究中，我们纳入了2018年1月至2023年4月在航空航天中心医院急诊科就诊的难治性OHCA患者.我们将患者分为ECPR组和CCPR组。研究的主要终点是两组患者在心脏骤停后3个月的神经功能。通过对ECPR组中神经功能良好的存活患者进行单变量和多变量相关分析，我们使用倾向评分匹配来减少选择偏倚，并确定OHCA接受ECPR治疗时与神经功能良好相关的因素。
结果：在研究期间，我们招募了133名患者，由ECPR组中的33和CCPR组中的100组成。出院时神经功能良好的患者,ECPR组为18.2%(6/33例),CCPR组为9%(9/100例),p=.20。出院三个月后,ECPR组神经功能良好患者的生存率为15.2%(5/33例),CCPR组为8%(8/100例),p=.31。使用倾向得分匹配，我们确定了22对患者进行进一步分析.其中,出院后3个月，ECPR组神经功能良好患者的生存率为13.6%(3/22例),CCPR组为4.5%(1/22例),p=.61,出院时生存率ECPR组为18.2%(4/22例),CCPR组为4.5%(1/22例),p=.34。ECPR组神经功能良好患者的单因素分析显示,无灌注时间,灌注不足时间,PCI治疗是影响患者神经功能预后的相关因素,多因素分析显示，灌注不足时间与良好的神经功能独立相关，OR（95%CI）为1.06（1.00-1.14），p=0.05。
结论：我们的研究结果表明，ECPR未能显著改善难治性OHCA患者的神经系统预后；然而，本研究中的小样本量可能不足以检测临床相关差异.此外,灌注不足时间可能是确定ECPR候选者的关键预测因素。
方法：在这项回顾性队列研究中，我们纳入了2018年1月至2023年4月在航空航天中心医院急诊科就诊的难治性OHCA患者.我们将患者分为ECPR组和CCPR组。研究的主要终点是两组患者在心脏骤停后3个月的神经功能。通过对ECPR组中神经功能良好的存活患者进行单变量和多变量相关分析，我们使用倾向评分匹配来减少选择偏倚，并确定OHCA接受ECPR治疗时与神经功能良好相关的因素。
结果：在研究期间，我们招募了133名患者，由ECPR组中的33和CCPR组中的100组成。出院时神经功能良好的患者,ECPR组为18.2%(6/33例),CCPR组为9%(9/100例),p=.20。出院三个月后,ECPR组神经功能良好患者的生存率为15.2%(5/33例),CCPR组为8%(8/100例),p=.31。使用倾向得分匹配，我们确定了22对患者进行进一步分析.其中,出院后3个月，ECPR组神经功能良好患者的生存率为13.6%(3/22例),CCPR组为4.5%(1/22例),p=.61,出院时生存率ECPR组为18.2%(4/22例),CCPR组为4.5%(1/22例),p=.34。ECPR组神经功能良好患者的单因素分析显示,无灌注时间,灌注不足时间,PCI治疗是影响患者神经功能预后的相关因素,多因素分析显示，灌注不足时间与良好的神经功能独立相关，OR（95%CI）为1.06（1.00-1.14），p=0.05。
结论：我们的研究结果表明，ECPR未能显著改善难治性OHCA患者的神经系统预后；然而，本研究中的小样本量可能不足以检测临床相关差异.此外,灌注不足时间可能是确定ECPR候选者的关键预测因素。
