PDF(Pubmed)
Abstract：
Refractory out-of-hospital cardiac arrest (OHCA) has a very poor prognosis, with survival rates at around 10%. Extracorporeal membrane oxygenation (ECMO) for patients in refractory arrest, known as ECPR, aims to provide perfusion to the patient whilst the underlying cause of arrest can be addressed. ECPR use has increased substantially, with varying survival rates to hospital discharge. The best outcomes for ECPR occur when the time from cardiac arrest to implementation of ECPR is minimised. To reduce this time, systems must be in place to identify the correct patient, expedite transfer to hospital, facilitate rapid cannulation and ECMO circuit flows. We describe the process of activation of ECPR, patient selection, and the steps that emergency department clinicians can utilise to facilitate timely cannulation to ensure the best outcomes for patients in refractory cardiac arrest. With these processes in place our survival to hospital discharge for OHCA patients is 35%, with most patients having a good neurological function.
摘要：
难治性院外心脏骤停（OHCA）的预后非常差，存活率在10%左右。难治性停搏患者的体外膜氧合（ECMO），被称为ECPR，旨在为患者提供灌注，同时可以解决阻止的根本原因。ECPR的使用大幅增加，不同的存活率到出院。ECPR的最佳结果发生在从心脏骤停到实施ECPR的时间最小化时。为了减少这段时间,系统必须到位，以识别正确的病人，加快转移到医院，促进快速插管和ECMO回路流动。我们描述了ECPR的激活过程，患者选择,以及急诊科临床医生可以使用的步骤来促进及时的插管，以确保难治性心脏骤停患者的最佳结果。有了这些流程，OHCA患者到出院的存活率为35%，大多数病人的神经功能都很好。
