目的:分析在西班牙一家三级医院实施多学科体外心肺复苏(ECPR)计划是否可行,并能产生与国际公开经验相似的生存结果。
方法:回顾性观察性队列研究。
方法:西班牙一所三级转诊大学医院。
方法:所有在2019年1月至2023年4月期间接受ECPR的成年患者。
方法:前瞻性收集变量并随访长达180天。
方法:为了评估结果,使用具有良好神经系统结局的生存率,定义为180天时的脑功能分类量表1-2。次要变量包括人口统计学和合并症,心脏骤停和插管的特点,ROSC,ECMO相关并发症,存活到ECMO拔管,重症监护病房(ICU)出院时的生存率,存活180天,神经系统的结果,死亡原因和器官捐献资格。
结果:54名患者接受了ECPR,OHCA为29,IHCA为25。在27名(50%)患者中发现了最初的可电击节律。心脏骤停最常见的原因是急性冠脉综合征[29(53.7%)],其次是肺栓塞[7(13%)]和意外低温[5(9.3%)]。16例(29.6%)患者在180天存活,15具有良好的神经系统效果。10名死亡患者(30.3%)在神经预后后成为器官捐献者。
结论:在西班牙经验丰富的体外膜氧合中心实施多学科ECPR计划是可行的,可以带来良好的生存结果和有效的器官捐献者。
OBJECTIVE: To analyze if the implementation of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program in a tertiary hospital in Spain is feasible and could yield survival outcomes similar to international published experiences.
METHODS: Retrospective observational cohort study.
METHODS: One tertiary referral university hospital in Spain.
METHODS: All adult patients receiving ECPR between January 2019 and April 2023.
METHODS: Prospective collection of variables and follow-up for up to 180 days.
METHODS: To assess outcomes, survival with good neurological outcome defined as a Cerebral Performance Categories scale 1-2 at 180 days was used. Secondary variables were collected including demographics and comorbidities, cardiac arrest and cannulation characteristics, ROSC, ECMO-related complications, survival to ECMO decannulation, survival at Intensive Care Unit (ICU) discharge, survival at 180 days, neurological outcome, cause of death and eligibility for organ donation.
RESULTS: Fifty-four patients received ECPR, 29 for OHCA and 25 for IHCA. Initial shockable rhythm was identified in 27 (50%) patients. The most common cause for cardiac arrest was acute coronary syndrome [29 (53.7%)] followed by pulmonary embolism [7 (13%)] and accidental hypothermia [5 (9.3%)]. Sixteen (29.6%) patients were alive at 180 days, 15 with good neurological outcome. Ten deceased patients (30.3%) became organ donors after neuroprognostication.
CONCLUSIONS: The implementation of a multidisciplinary ECPR program in an experienced Extracorporeal Membrane Oxygenation center in Spain is feasible and can lead to good survival outcomes and valid organ donors.