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Abstract：
OBJECTIVE: Extracorporeal cardiopulmonary resuscitation (ECPR) might markedly increase the survival of selected patients with refractory cardiac arrest. But the application situation and indications remained unclear.
METHODS: We respectively reviwed all adult patients who underwent ECPR from January 2017 to March 2021. Patient characteristics, initiation and management of ECMO, complications, and outcomes were collected and compared between the survivors and nonsurvivors. LASSO regression was used to screen risk factors. Multivariate logistic regression was performed with several parameters screened by LASSO regression.
RESULTS: Data were reported from 42 ECMO centers covering 19 provinces of China. A total of 648 patients were included in the study, including 491 (75.8%) males. There were 11 ECPR centers in 2017, and the number increased to 42 in 2020. The number of patients received ECPR increased from 33 in 2017 to 274 in 2020, and the survival rate increased from 24.2% to 33.6%. Neurological complications, renal replacement therapy, epinephrine dosage after ECMO, recovery of spontaneous circulation before ECMO, lactate clearance and shockable rhythm were risk factors independently associated with outcomes of whole process. Sex, recovery of spontaneous circulation before ECMO, lactate, shockable rhythm and causes of arrest were pre-ECMO risk factors independently affecting outcomes.
CONCLUSIONS: From January 2017 to March 2021, the numbers of ECPR centers and cases in mainland China increased gradually over time, as well as the survival rate. Pre-ECMO risk factors, especially recovery of spontaneous circulation before ECMO, shockable rhythm and lactate, are as important as post-ECMO management,. Neurological complications are vital risk factors after ECMO that deserved close attention.
BACKGROUND: NCT04158479, registered on 2019/11/08. https://clinicaltrials.gov/NCT04158479.
METHODS: We respectively reviwed all adult patients who underwent ECPR from January 2017 to March 2021. Patient characteristics, initiation and management of ECMO, complications, and outcomes were collected and compared between the survivors and nonsurvivors. LASSO regression was used to screen risk factors. Multivariate logistic regression was performed with several parameters screened by LASSO regression.
RESULTS: Data were reported from 42 ECMO centers covering 19 provinces of China. A total of 648 patients were included in the study, including 491 (75.8%) males. There were 11 ECPR centers in 2017, and the number increased to 42 in 2020. The number of patients received ECPR increased from 33 in 2017 to 274 in 2020, and the survival rate increased from 24.2% to 33.6%. Neurological complications, renal replacement therapy, epinephrine dosage after ECMO, recovery of spontaneous circulation before ECMO, lactate clearance and shockable rhythm were risk factors independently associated with outcomes of whole process. Sex, recovery of spontaneous circulation before ECMO, lactate, shockable rhythm and causes of arrest were pre-ECMO risk factors independently affecting outcomes.
CONCLUSIONS: From January 2017 to March 2021, the numbers of ECPR centers and cases in mainland China increased gradually over time, as well as the survival rate. Pre-ECMO risk factors, especially recovery of spontaneous circulation before ECMO, shockable rhythm and lactate, are as important as post-ECMO management,. Neurological complications are vital risk factors after ECMO that deserved close attention.
BACKGROUND: NCT04158479, registered on 2019/11/08. https://clinicaltrials.gov/NCT04158479.
摘要：
目的：体外心肺复苏（ECPR）可显著提高部分难治性心脏骤停患者的生存率。但应用情况和适应症仍不清楚。
方法：我们分别对2017年1月至2021年3月接受ECPR的所有成年患者进行了回顾。患者特征,ECMO的启动和管理，并发症,收集和比较幸存者和非幸存者的结局.采用LASSO回归筛选危险因素。用LASSO回归法筛选的几个参数进行多因素logistic回归。
结果：数据来自中国19个省的42个ECMO中心。共有648名患者被纳入研究，包括491名(75.8%)男性。2017年有11个ECPR中心，到2020年增加到42个。接受ECPR的患者人数从2017年的33人增加到2020年的274人，生存率从24.2％增加到33.6％。神经系统并发症,肾脏替代疗法,ECMO后的肾上腺素剂量，ECMO前自发循环恢复，乳酸清除率和可电击节律是与整个过程结局独立相关的危险因素.性,ECMO前自发循环恢复，乳酸，电击节律和停搏的原因是ECMO前独立影响结局的危险因素.
结论：从2017年1月到2021年3月，随着时间的推移，中国大陆的ECPR中心和病例数量逐渐增加，以及存活率。ECMO前风险因素，尤其是ECMO前的自发循环恢复，可电击节律和乳酸，与ECMO后的管理一样重要，.神经系统并发症是ECMO术后的重要危险因素，值得密切关注。
背景：NCT04158479，于2019/11/08注册。https://clinicaltrials.gov/NCT04158479.
方法：我们分别对2017年1月至2021年3月接受ECPR的所有成年患者进行了回顾。患者特征,ECMO的启动和管理，并发症,收集和比较幸存者和非幸存者的结局.采用LASSO回归筛选危险因素。用LASSO回归法筛选的几个参数进行多因素logistic回归。
结果：数据来自中国19个省的42个ECMO中心。共有648名患者被纳入研究，包括491名(75.8%)男性。2017年有11个ECPR中心，到2020年增加到42个。接受ECPR的患者人数从2017年的33人增加到2020年的274人，生存率从24.2％增加到33.6％。神经系统并发症,肾脏替代疗法,ECMO后的肾上腺素剂量，ECMO前自发循环恢复，乳酸清除率和可电击节律是与整个过程结局独立相关的危险因素.性,ECMO前自发循环恢复，乳酸，电击节律和停搏的原因是ECMO前独立影响结局的危险因素.
结论：从2017年1月到2021年3月，随着时间的推移，中国大陆的ECPR中心和病例数量逐渐增加，以及存活率。ECMO前风险因素，尤其是ECMO前的自发循环恢复，可电击节律和乳酸，与ECMO后的管理一样重要，.神经系统并发症是ECMO术后的重要危险因素，值得密切关注。
背景：NCT04158479，于2019/11/08注册。https://clinicaltrials.gov/NCT04158479.
