PDF(Pubmed)
Abstract：
Recently, patients with out-of-hospital cardiac arrest (OHCA) refractory to conventional resuscitation have started undergoing extracorporeal cardiopulmonary resuscitation (ECPR). However, the mortality rate of these patients remains high. This study aimed to clarify whether a center ECPR volume was associated with the survival rates of adult patients with OHCA resuscitated using ECPR. This was a secondary analysis of a retrospective multicenter registry study, the SAVE-J II study, involving 36 participating institutions in Japan. Centers were divided into three groups according to the tertiles of the annual average number of patients undergoing ECPR: high-volume (≥ 21 sessions per year), medium-volume (11-20 sessions per year), or low-volume (< 11 sessions per year). The primary outcome was survival rate at the time of discharge. Patient characteristics and outcomes were compared among the three groups. Moreover, a multivariable-adjusted logistic regression model was applied to study the impact of center ECPR volume. A total of 1740 patients were included in this study. The center ECPR volume was strongly associated with survival rate at the time of discharge; furthermore, survival rate was best in high-volume compared with medium- and low-volume centers (33.4%, 24.1%, and 26.8%, respectively; P = 0.001). After adjusting for patient characteristics, undergoing ECPR at high-volume centers was associated with an increased likelihood of survival compared to middle- (adjusted odds ratio 0.657; P = 0.003) and low-volume centers (adjusted odds ratio 0.983; P = 0.006). The annual number of ECPR sessions was associated with favorable survival rates and lower complication rates of the ECPR procedure.Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 (unique identifier: UMIN000036490).
摘要：
最近,常规复苏难以治疗的院外心脏骤停(OHCA)患者已开始接受体外心肺复苏(ECPR).然而,这些患者的死亡率仍然很高。本研究旨在阐明中心ECPR容量是否与使用ECPR复苏的成年OHCA患者的生存率相关。这是一项回顾性多中心注册研究的二次分析，SAVE-JII研究，涉及日本36个参与机构。根据接受ECPR的患者的年平均人数，中心分为三组：高容量（每年≥21次），中等数量(每年11-20届)，或低量（每年少于11个会议）。主要结果是出院时的生存率。比较三组患者的特征和结果。此外，采用多变量校正逻辑回归模型研究中心ECPR体积的影响.本研究共纳入1740例患者。中心ECPR体积与出院时的生存率密切相关；此外，与中、低容量中心相比，高容量中心的存活率最好(33.4%，24.1%,和26.8%，分别；P=0.001）。在针对患者特征进行调整后,与中容量中心(校正比值比0.657;P=0.003)和低容量中心(校正比值比0.983;P=0.006)相比,在高容量中心接受ECPR的生存可能性增加.每年的ECPR会议次数与ECPR程序的良好生存率和较低的并发症发生率相关。临床试验注册：https://center6。乌明。AC.jp/cgi-open-bin/ctr_e/ctr_view。cgi?recptno=R000041577（唯一标识符：UMIN000036490）。
