背景:事件的时间顺序的影响,包括心脏骤停(CA),初次心肺复苏术(CPR),自主循环恢复(ROSC),和体外心肺复苏(ECPR)的实施,院外心脏骤停(OHCA)和院内心脏骤停(IHCA)患者的临床结局,仍然不清楚。这项研究的目的是调查从崩溃到开始CPR的时间间隔的预后影响(无流量时间,NFT)和从CPR开始到实施ECPR的时间间隔(低流量时间,LFT)关于体外膜氧合(ECMO)下患者的预后。
方法:这种单中心,在哈马德总医院(HGH)对48例接受ECMO的OHCA或IHCA患者进行了回顾性观察研究,卡塔尔三级政府医院,2016年2月至2020年3月。我们调查了NFT和LFT等预后因素对心脏骤停后各种临床结局的影响。包括24小时存活,28天存活,CPR持续时间,ECMO逗留时间(LOS),ICULOS,医院LOS,残疾(使用改良的Rankin量表评估,mRS),和神经状态(根据大脑性能类别评估,CPC)在CA后28天。
结果:调整后的logistic回归分析结果显示,NFT时间较长与临床结局不良相关。这些结果包括CPR持续时间延长(OR:1.779,95CI:1.218-2.605,P=0.034)和ECMO在24h(OR:0.561,95CI:0.183-0.903,P=0.009)和28天(OR:0.498,95CI:0.106-0.802,P=0.011)的生存率降低。此外,研究发现,LFT越长,CPR时间越长的概率越高(OR:1.818,95CI:1.332~3.312,P=0.006).然而,心脏骤停28天后,NFT或LFT与残疾改善或神经系统有利生存率之间无统计学意义的联系.
结论:根据我们的发现,在评估接受ECMO治疗的OHCA或IHCA患者的临床结局方面,NFT比LFT更有效.这种对他们独特预测能力的理解使医疗专业人员能够更准确地识别高风险患者,并相应地定制他们的干预措施。
BACKGROUND: The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this
study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO).
METHODS: This single-center, retrospective observational
study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA.
RESULTS: The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest.
CONCLUSIONS: Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.