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首页> 外文期刊>The Lancet >Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.
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Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.

机译：辅助性体外生命支持的心肺复苏术与常规心肺复苏术在院内心脏骤停的成年人中的疗效：一项观察性研究和倾向性分析。

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BACKGROUND: Extracorporeal life-support as an adjunct to cardiac resuscitation has shown encouraging outcomes in patients with cardiac arrest. However, there is little evidence about the benefit of the procedure compared with conventional cardiopulmonary resuscitation (CPR), especially when continued for more than 10 min. We aimed to assess whether extracorporeal CPR was better than conventional CPR for patients with in-hospital cardiac arrest of cardiac origin. METHODS: We did a 3-year prospective observational study on the use of extracorporeal life-support for patients aged 18-75 years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min compared with patients receiving conventional CPR. A matching process based on propensity-score was done to equalise potential prognostic factors in both groups, and to formulate a balanced 1:1 matched cohort study. The primary endpoint was survival to hospital discharge, and analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00173615. FINDINGS: Of the 975 patients with in-hospital cardiac arrest events who underwent CPR for longer than 10 min, 113 were enrolled in the conventional CPR group and 59 were enrolled in the extracorporeal CPR group. Unmatched patients who underwent extracorporeal CPR had a higher survival rate to discharge (log-rank p<0.0001) and a better 1-year survival than those who received conventional CPR (log rank p=0.007). Between the propensity-score matched groups, there was still a significant difference in survival to discharge (hazard ratio [HR] 0.51, 95% CI 0.35-0.74, p<0.0001), 30-day survival (HR 0.47, 95% CI 0.28-0.77, p=0.003), and 1-year survival (HR 0.53, 95% CI 0.33-0.83, p=0.006) favouring extracorporeal CPR over conventional CPR. INTERPRETATION: Extracorporeal CPR had a short-term and long-term survival benefit over conventional CPR in patients with in-hospital cardiac arrest of cardiac origin.
机译：背景：体外生命支持作为心脏复苏的辅助手段已显示出令人鼓舞的心脏骤停患者预后。但是，与常规心肺复苏（CPR）相比，尚无证据表明该手术的益处，尤其是持续时间超过10分钟时。我们旨在评估心脏源性院内心脏骤停患者的体外CPR是否优于常规CPR。方法：我们进行了一项为期三年的前瞻性观察性研究，研究了18-75岁年龄段患者的院内心脏骤停发生CPR超过10分钟（与接受常规CPR的患者相比）的体外生命支持。进行了基于倾向评分的匹配过程，以使两组的潜在预后因素均等，并制定了平衡的1：1匹配队列研究。主要终点是出院生存率，而分析是根据治疗意愿进行的。该研究已在ClinicalTrials.gov上注册，编号为NCT00173615。结果：在975例接受CPR超过10分钟的院内心脏骤停事件的患者中，有113例被纳入常规CPR组，而59例被纳入体外CPR组。与接受常规CPR的患者相比，接受体外CPR的无匹配患者出院生存率更高（log-rank p <0.0001），并且一年生存率更高（log rank p = 0.007）。在倾向得分匹配组之间，出院生存率（危险比[HR] 0.51，95％CI 0.35-0.74，p <0.0001），30天生存率（HR 0.47，95％CI 0.28）仍然存在显着差异-0.77，p = 0.003）和1年生存期（HR 0.53，95％CI 0.33-0.83，p = 0.006）较常规CPR更倾向于体外CPR。解释：在院内心脏骤停患者中，体外CPR比常规CPR有短期和长期生存获益。

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