Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?

doi:10.1186/s13049-020-00753-6

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/24402

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题名:	Can we predict patient outcome before extracorporeal membrane oxygenation for refractory cardiac arrest?
作者:	Siao, FY;Chiu, CW;Chiu, CC;Chang, YJ;Chen, YC;Chen, YL;Hsieh, YK;Chou, CC;Yen, HH
关键词:	Refractory cardiac arrest;Out-of-hospital cardiac arrest;In-hospital cardiac arrest;Emergency department cardiac arrest;Extracorporeal cardiopulmonary resuscitation;Extracorporeal membrane oxygenation
日期:	2020
上传时间:	2022-08-09T08:01:42Z (UTC)
出版者:	BMC
ISSN:	1757-7241
摘要:	Background Refractory cardiac arrest resistant to conventional cardiopulmonary resuscitation (C-CPR) has a poor outcome. Although previous reports showed that extracorporeal cardiopulmonary resuscitation (E-CPR) can improve the clinical outcome, there are no clinically applicable predictors of patient outcome that can be used prior to the implementation of E-CPR. We aimed to evaluate the use of clinical factors in patients with refractory cardiac arrest undergoing E-CPR to predict patient outcome in our institution. Methods This is a single-center retrospective study. We report 112 patients presenting with refractory cardiac arrest resistant to C-CPR between January 2012 and November 2017. All patients received E-CPR for continued life support when a cardiogenic etiology was presumed. Clinical factors associated with patient outcome were analyzed. Significant pre-ECMO clinical factors were extracted to build a patient outcome risk prediction model. Results The overall survival rate at discharge was 40.2, and 30.4% of patients were discharged with good neurologic function. The six-month survival rate after hospital discharge was 36.6, and 25.9% of patients had good neurologic function 6 months after discharge. We stratified the patients into low-risk (n = 38), medium-risk (n = 47), and high-risk groups (n = 27) according to the TLR score (low-flowTime, cardiac arrestLocation, and initial cardiac arrestRhythm) that we derived from pre-ECMO clinical parameters. Compared with the medium-risk and high-risk groups, the low-risk group had better survival at discharge (65.8% vs. 42.6% vs. 0%,p < 0.0001) and at 6 months (60.5% vs. 38.3% vs. 0%,p = 0.0001). The low-risk group also had a better neurologic outcome at discharge (50% vs. 31.9% vs. 0%,p = 0.0001) and 6 months after discharge (44.7% vs. 25.5% vs. 0%,p = 0.0003) than the medium-risk and high-risk groups. Conclusions Patients with refractory cardiac arrest receiving E-CPR can be stratified by pre-ECMO clinical factors to predict the clinical outcome. Larger-scale studies are required to validate our observations.
URI:	http://dx.doi.org/10.1186/s13049-020-00753-6 https://www.webofscience.com/wos/woscc/full-record/WOS:000545667500002 https://ir.csmu.edu.tw:8080/handle/310902500/24402
關聯:	SCANDINAVIAN JOURNAL OF TRAUMA RESUSCITATION & EMERGENCY MEDICINE ,2020 ,v28 ,issue 1
显示于类别:	[中山醫學大學研究成果] 期刊論文

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