院內CPR最好能有「葉醫師」幫忙

ECMO May Improve In-Hospital Cardiac Arrest Outcomes
Cardiopulmonary resuscitation using extracorporeal membrane oxygenation improved survival compared with conventional CPR alone.

Indications for using extracorporeal membrane oxygenation (ECMO) to augment cardiopulmonary resuscitation (E-CPR) are ill-defined. Researchers retrospectively analyzed outcomes in 406 patients aged 18 to 80 with witnessed in-hospital cardiac arrest who underwent CPR for at least 10 minutes in a single hospital in Korea during a 6-year period. Patients with poor baseline neurologic status, acute intracranial hemorrhage, terminal cancer, traumatic hemorrhagic shock, irreversible organ failure, or sepsis were excluded.

Resuscitation team leaders made the decision to initiate ECMO (available within 5–10 minutes during the day and 10–20 minutes at night). In most cases, E-CPR was initiated in patients with known severe left ventricular dysfunction, prolonged arrest (no return of spontaneous circulation after 10–20 minutes), or recurrent arrest. E-CPR was established in 80 of 85 patients in whom it was attempted, and conventional CPR alone was performed in 321 patients.

Using propensity score analysis, the authors calculated that the E-CPR group had significantly higher rates of survival to hospital discharge with minimal neurologic impairment (odds ratio for mortality or neurologic deficit, 0.17) and survival to 6 months with minimal neurologic impairment (hazard ratio for neurologic impairment, 0.48) than patients in the conventional CPR group. Results were similar in the subgroup of patients with arrest from cardiac origin.

Comment: Although ECMO is not available within minutes in all hospitals, it seems to provide significant benefit to patients with poor left ventricular function or prolonged or recurrent arrest. Pending a randomized trial, it is reasonable to consider using ECMO in such patients.

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Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine December 29, 2010
Citation(s): Shin TG et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation. Crit Care Med 2011 Jan; 39:1.