体外心肺复苏术。
Extracorporeal Cardiopulmonary Resuscitation.
机构信息
Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, University Hospital Cologne, Cologne, Germany; Center for Resuscitation Medicine, University of Minnesota, Minneapolis, USA; Emergency Department (UNZ), Medical Center - University of Freiburg, Medical Faculty, Freiburg, Germany.
出版信息
Dtsch Arztebl Int. 2023 Oct 20;120(42):703-710. doi: 10.3238/arztebl.m2023.0189.
BACKGROUND
Around the world, survival rates after cardiac arrest range between <14% for in-hospital (IHCA) and <10% for outof- hospital cardiac arrest (OHCA). This situation could potentially be improved by using extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR), i.e. by extracorporeal cardiopulmonary resuscitation (ECPR).
METHODS
A selective literature search of Pubmed and Embase using the searching string ((ECMO) OR (ECLS)) AND (ECPR)) was carried out in February 2023 to prepare an up-to-date review of published trials comparing the outcomes of ECPR with those of conventional CPR.
RESULTS
Out of 573 initial results, 12 studies were included in this review, among them three randomized controlled trials comparing ECPR with CPR, involving a total of 420 patients. The survival rates for ECPR ranged from 20% to 43% for OHCA and 20% to 30.4% for IHCA. Most of the publications were associated with a high degree of bias and a low level of evidence.
CONCLUSION
ECPR can potentially improve survival rates after cardiac arrest compared to conventional CPR when used in experienced, high-volume centers in highly selected patients (young age, initial shockable rhythm, witnessed cardiac arrest, therapy-refractory high-quality CPR). No general recommendation for the use of ECPR can be issued at present.
背景
在全球范围内，心脏骤停后的存活率在院内（IHCA）为<14%，院外（OHCA）为<10%。这种情况可以通过在心肺复苏（CPR）期间使用体外膜氧合（ECMO），即体外心肺复苏（ECPR）来改善。
方法
2023 年 2 月，我们对 Pubmed 和 Embase 进行了选择性文献检索，使用的检索词为（ECMO）或（ECLS）和（ECPR），以准备一份关于比较 ECPR 与常规 CPR 结果的已发表试验的最新综述。
结果
在最初的 573 项结果中，有 12 项研究纳入了本综述，其中包括 3 项比较 ECPR 与 CPR 的随机对照试验，共涉及 420 例患者。OHCA 的 ECPR 生存率为 20%至 43%，IHCA 的 ECPR 生存率为 20%至 30.4%。大多数出版物与高度偏倚和低证据水平相关。
结论
在经验丰富、高容量的中心，对高度选择的患者（年轻、初始可除颤节律、目击性心脏骤停、治疗抵抗性高质量 CPR）使用 ECPR 可能会比常规 CPR 提高心脏骤停后的生存率。目前不能对 ECPR 的使用提出一般建议。
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