留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

院前体外心肺复苏: 现状与前景

史晓朋 杨蕾 程艳伟 白伟民 景莉娟 秦历杰

史晓朋, 杨蕾, 程艳伟, 白伟民, 景莉娟, 秦历杰. 院前体外心肺复苏: 现状与前景[J]. 协和医学杂志, 2023, 14(3): 478-483. doi: 10.12290/xhyxzz.2022-0675
引用本文: 史晓朋, 杨蕾, 程艳伟, 白伟民, 景莉娟, 秦历杰. 院前体外心肺复苏: 现状与前景[J]. 协和医学杂志, 2023, 14(3): 478-483. doi: 10.12290/xhyxzz.2022-0675
SHI Xiaopeng, YANG Lei, CHENG Yanwei, BAI Weimin, JING Lijuan, QIN Lijie. Prehospital Extracorporeal Cardiopulmonary Resuscitation in Out-of-hospital Cardiac Arrest[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(3): 478-483. doi: 10.12290/xhyxzz.2022-0675
Citation: SHI Xiaopeng, YANG Lei, CHENG Yanwei, BAI Weimin, JING Lijuan, QIN Lijie. Prehospital Extracorporeal Cardiopulmonary Resuscitation in Out-of-hospital Cardiac Arrest[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(3): 478-483. doi: 10.12290/xhyxzz.2022-0675

院前体外心肺复苏: 现状与前景

doi: 10.12290/xhyxzz.2022-0675
详细信息
    通讯作者:

    秦历杰, E-mail:qinlijie1819@163.com

  • 中图分类号: R459.7

Prehospital Extracorporeal Cardiopulmonary Resuscitation in Out-of-hospital Cardiac Arrest

More Information
  • 摘要: 对于传统心肺复苏不能恢复或维持自主心律的心脏骤停患者, 通过建立体外膜肺氧合快速实施体外心肺复苏(extracorporeal cardiopulmonary resuscitation, ECPR)可维持重要器官的血流灌注, 提高心肺复苏成功率, 改善患者预后。院前实施ECPR可最大化减少心脏骤停患者循环不充分的时间, 但因其投入巨大, 且受场地条件限制较多, 临床推广受到一定限制, 因此在团队协作、流程实施及最佳受益人群方面仍有待更深入的研究。目前国内外已有部分医疗机构开展了院前ECPR策略, 并取得了一定成效。本文就院前ECPR实施现状及要点进行概述, 并对未来应用前景进行展望。
    作者贡献:史晓朋负责论文撰写;秦历杰负责选题设计、论文修订;杨蕾、程艳伟、白伟民、景莉娟负责文献分析。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  院前ECPR启动流程图

    OHCA:院外心脏骤停;CCPR:传统心肺复苏;ROSC:自主循环恢复;ECMO:体外膜肺氧合;ECPR:同表 1;EICU:急诊监护病房

    表  1  院前ECPR评分系统

    评估项目 评分
    目击下的心脏骤停 1
    初始心律为可除颤心律 1
    可逆性病因 1
    年龄<65岁 1
    pH值>7.0 1
    呼气末二氧化碳分压<10 mm Hg 1
    血乳酸<7 mmol/L 1
    总分 7
    ECPR:体外心肺复苏
    下载: 导出CSV
  • [1] Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death[J]. Circulation, 2012, 125: 620-637. doi:  10.1161/CIRCULATIONAHA.111.023838
    [2] Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association[J]. Circulation, 2021, 143: e254-e743. doi:  10.1161/CIRCULATIONAHA.120.046677
    [3] Extracorporeal Life Support Organization. ECLS Registry Report[EB/OL]. (2022-10-19)[2022-11-27]. https://www.elso.org/registry/internationalsummaryandreports/internationalsummary.aspx.
    [4] Yannopoulos D, Bartos JA, Martin C, et al. Minnesota Resuscitation Consortium's Advanced Perfusion and Reperfusion Cardiac Life Support Strategy for Out-of-Hospital Refractory Ventricular Fibrillation[J]. J Am Heart Assoc, 2016, 5: e003732. doi:  10.1161/JAHA.116.003732
    [5] Yannopoulos D, Bartos JA, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial[J]. Lancet, 2020, 396: 1807-1816. doi:  10.1016/S0140-6736(20)32338-2
    [6] Hsu CH, Meurer WJ, Domeier R, et al. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized Feasibility Trial of Expedited Out-of-Hospital Transport[J]. Ann Emerg Med, 2021, 78: 92-101. doi:  10.1016/j.annemergmed.2020.11.011
    [7] D'Arrigo S, Cacciola S, Dennis M, et al. Predictors of favourable outcome after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation: A systematic review and meta-analysis[J]. Resuscitation, 2017, 121: 62-70. doi:  10.1016/j.resuscitation.2017.10.005
    [8] Bartos JA, Frascone RJ, Conterato M, et al. The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: Program description, performance, and outcomes[J]. EClinical Medicine, 2020, 29-30: 100632. doi:  10.1016/j.eclinm.2020.100632
    [9] Hutin A, Ricard-Hibon A, Briole N, et al. First Description of a Helicopter-Borne ECPR Team for Remote Refractory Out-of-Hospital Cardiac Arrest[J]. Prehosp Emerg Care, 2021. doi:  10.1080/10903127.2020.1859026.
    [10] Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults[J]. J Am Coll Cardiol, 2014, 63: 2769-2778. doi:  10.1016/j.jacc.2014.03.046
    [11] Bělohlávek J, Mlček M, Huptych M, et al. Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation[J]. Crit Care, 2012, 16: R50. doi:  10.1186/cc11254
    [12] Yu HY, Wang CH, Chi NH, et al. Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation[J]. Intensive Care Med, 2019, 45: 44-54. doi:  10.1007/s00134-018-5496-y
    [13] Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation, 2015, 132: S444-S464. http://smartsearch.nstl.gov.cn/paper_detail.html?id=3c8a94d517ceae67112e7e6804f2d3a8
    [14] Brooks SC, Anderson ML, Bruder E, et al. Part 6: Alternative Techniques and Ancillary Devices for Cardiopul-monary Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation, 2015, 132: S436-S443. http://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsRW5nTmV3UzIwMjEwMzAyEiAyN2U1MTQwNDI5YzA5NmRlZTRiMTgzZGZhOTA2OWU0MBoIeTRyaTE0OGw%3D
    [15] Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J]. Circulation, 2020, 142: S366-S468. http://pubmed.ncbi.nlm.nih.gov/33081529/
    [16] Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support[J]. Resuscitation, 2021, 161: 115-151. doi:  10.1016/j.resuscitation.2021.02.010
    [17] Lamhaut L, Hutin A, Puymirat E, et al. A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis[J]. Resuscitation, 2017, 117: 109-117. doi:  10.1016/j.resuscitation.2017.04.014
    [18] Marinaro J, Guliani S, Dettmer T, et al. Out-of-hospital extracorporeal membrane oxygenation cannulation for refractory ventricular fibrillation: a case report[J]. J Am Coll Emerg Physicians Open, 2020, 1: 153-157. doi:  10.1002/emp2.12033
    [19] 中国老年医学学会急诊医学分会, 中国老年医学学会急诊医学分会ECMO工作委员会. 成人体外膜肺氧合辅助心肺复苏(ECPR)实践路径[J]. 中华急诊医学杂志, 2019, 28: 1197-1203. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS202009008.htm
    [20] Alwardt CM, Wilson DS, Alore ML, Lanza LA, Devaleria PA, Pajaro OE. Performance and Safety of an Integrated Portable Extracorporeal Life Support System for Adults[J]. J Extra Corpor Technol, 2015, 47: 38-43. http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=PMC4566819&blobtype=pdf
    [21] 于洁, 乔叶薷, 马金辉, 等. 基于德尔菲法构建体外膜肺氧合辅助心肺复苏临床治疗专家共识[J]. 中国体外循环杂志, 2016, 14: 193-196. https://www.cnki.com.cn/Article/CJFDTOTAL-TWXH201604002.htm
    [22] 中华医学会急诊医学分会复苏学组, 成人体外心肺复苏专家共识组. 成人体外心肺复苏专家共识[J]. 中华急诊医学杂志, 2018, 27: 22-29.
    [23] Laussen PC, Guerguerian Anne-Marie. Establishing and Sustaining an ECPR Program[J]. Front Pediatr, 2018, 6: 152. doi:  10.3389/fped.2018.00152
    [24] Debaty G, Babaz V, Durand M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest[J]. Resuscitation, 2017, 112: 1-10. doi:  10.1016/j.resuscitation.2016.12.011
    [25] Mosier JM, Kelsey M, Raz Y, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions[J]. Crit Care, 2015, 19: 431. doi:  10.1186/s13054-015-1155-7
    [26] Bartos JA, Yannopoulos D. Refractory cardiac arrest: where extracorporeal cardiopulmonary resuscitation fits[J]. Curr Opin Crit Care, 2020, 26: 596-602. doi:  10.1097/MCC.0000000000000769
    [27] Bartos JA, Grunau B, Carlson C, et al. Improved Survival With Extracorporeal Cardiopulmonary Resuscita-tion Despite Progres-sive Metabolic Derangement Associated With Prolonged Resuscitation[J]. Circulation, 2020, 141: 877-886. doi:  10.1161/CIRCULATIONAHA.119.042173
    [28] Reynolds JC, Grunau BE, Elmer J, et al. Prevalence, natural history, and time-dependent outcomes of a multi-center North American cohort of out-of-hospital cardiac arrest extracorporeal CPR candidates[J]. Resuscitation, 2017, 117: 24-31. doi:  10.1016/j.resuscitation.2017.05.024
    [29] Han SJ, Kim HS, Choi HH, et al. Predictors of survival following extracorporeal cardiopulmonary resuscitation in patients with acute myocardial infarction-complicated refractory cardiac arrest in the emergency department: a retrospective study[J]. J Cardiothorac Surg, 2015, 10: 23. doi:  10.1186/s13019-015-0212-2
    [30] Chonde M, Escajeda J, Elmer J, et al. Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest[J]. Resuscitation, 2020, 148: 259-265. doi:  10.1016/j.resuscitation.2019.12.015
    [31] Douflé G, Roscoe A, Billia F, et al. Echocardiography for adult patients supported with extracorporeal membrane oxygenation published correction appears in Crit Care[J]. Crit Care, 2015, 19: 326. doi:  10.1186/s13054-015-1042-2
    [32] MacLaren G, Masoumi A, Brodie D. ECPR for out-of-hospital cardiac arrest: more evidence is needed[J]. Crit Care, 2020, 24: 7. doi:  10.1186/s13054-019-2722-0
    [33] Girotra S, Nallamothu BK, Spertus JA, et al. Trends in survival after in-hospital cardiac arrest[J]. N Engl J Med, 2012, 367: 1912-1920. doi:  10.1056/nejmoa1109148
  • 加载中
图(1) / 表(1)
计量
  • 文章访问数:  1625
  • HTML全文浏览量:  79
  • PDF下载量:  130
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-11-27
  • 录用日期:  2023-02-07
  • 网络出版日期:  2023-02-16
  • 刊出日期:  2023-05-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!