Abstract：
Out-of-hospital cardiac arrest (OHCA) is associated with very poor outcomes. Extracorporeal cardiopulmonary resuscitation (eCPR) for selected patients is a potential therapeutic option for refractory cardiac arrest. However, randomised controlled studies applying eCPR after refractory OHCA have demonstrated conflicting results regarding survival and good functional neurological outcomes. eCPR is an invasive, labour-intensive, and expensive therapeutic approach with associated side-effects. A rapid monitoring device would be valuable in facilitating selection of appropriate patients for this expensive and complex treatment. To this end, rapid diagnosis of hyperfibrinolysis, or premature clot dissolution, diagnosed by viscoelastic testing might represent a feasible option. Hyperfibrinolysis is an evolutionary response to low or no-flow states. Studies in trauma patients demonstrate a high mortality rate in those with established hyperfibrinolysis upon emergency room admission. Similar findings have now been reported for the first time in OHCA patients. Hyperfibrinolysis upon admission diagnosed by rotational thromboelastometry was strongly associated with mortality and poor neurological outcomes in a small cohort of patients treated with extracorporeal membrane oxygenation.
摘要：
院外心脏骤停（OHCA）与非常差的结果相关。针对某些患者的体外心肺复苏（eCPR）是难治性心脏骤停的潜在治疗选择。然而,在难治性OHCA后应用eCPR的随机对照研究显示,在生存率和良好的神经功能结局方面存在矛盾的结果.eCPR是一种侵入性的，劳动密集型,和昂贵的治疗方法与相关的副作用。快速监测设备在促进为这种昂贵和复杂的治疗选择合适的患者方面将是有价值的。为此,纤溶亢进的快速诊断，或者凝块过早溶解,通过粘弹性测试诊断可能是一种可行的选择。高纤维蛋白溶解是对低流量或无流量状态的进化反应。对创伤患者的研究表明，在急诊室入院时已确定纤溶亢进的患者死亡率很高。类似的发现现在已经在OHCA患者中首次报道。在接受体外膜氧合治疗的一小部分患者中，通过旋转血栓弹性测定法诊断为入院时的纤溶亢进与死亡率和不良的神经系统预后密切相关。
