Background: Likelihood of neurologically favorable survival declines with prolonged resuscitation. However, the ability of extracorporeal cardiopulmonary resuscitation (ECPR) to modulate this decline is unknown. We aimed to examine the effects of resuscitation duration on survival and metabolic profile in patients who undergo ECPR for refractory ventricular fibrillation/ventricular tachycardia out-of-hospital cardiac arrest (VF/VT OHCA). Methods: We retrospectively evaluated survival in 160 consecutive adults with refractory VF/VT OHCA treated with the UMN-ECPR protocol (transport with ongoing CPR to the cardiac catheterization laboratory for ECPR) compared with 654 adults who had received standard CPR in the amiodarone arm of the ALPS trial. We evaluated the metabolic changes and rate of survival in relation to duration of CPR in UMN-ECPR patients. Results: Neurologically favorable survival was significantly higher in UMN-ECPR patients vs. ALPS patients (33% vs. 23%; p = 0.01) overall. The mean duration of CPR was also significantly longer for UMN-ECPR patients vs. ALPS patients (60 vs. 35 min; p < 0.001). Analysis of the effect of CPR duration on neurologically favorable survival demonstrated significantly higher neurologically favorable survival for UMN-ECPR patients compared to ALPS patients at each CPR duration interval less than 60 minutes; however, longer CPR duration was associated with progressive decline in neurologically favorable survival in both groups. All UMN-ECPR patients with 20-29 minutes of CPR (8/8) survived with neurologically favorable status compared to 24% (24/102) for ALPS patients with the same duration of CPR. There were no neurologically favorable survivors in the ALPS cohort with CPR {greater than or equal to}40 minutes, whereas neurologically favorable survival was 25% (9/36) for UMN-ECPR patients with 50-59 minutes of CPR and 19% with {greater than or equal to}60 minutes. Relative risk of mortality or poor neurologic function was significantly reduced in UMN-ECPR patients with CPR duration {greater than or equal to} 60 minutes, Significant metabolic changes included decline in pH, increased lactic acid and paCO2, and thickened left ventricular wall with prolonged professional CPR. Conclusions: ECPR was associated with improved neurologically favorable survival at all CPR durations less than 60 minutes despite severe progressive metabolic derangement. However, CPR duration remains a critical determinate of survival.

中文翻译：

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尽管与长期复苏相关的进行性代谢紊乱，体外心肺复苏提高了生存率。

背景：随着复苏时间的延长，神经系统良好存活的可能性会下降。然而，体外心肺复苏 (ECPR) 调节这种下降的能力尚不清楚。我们旨在检查复苏持续时间对因难治性心室颤动/室性心动过速院外心脏骤停 (VF/VT OHCA) 接受 ECPR 的患者的生存和代谢特征的影响。方法：我们回顾性地评估了 160 名接受 UMN-ECPR 方案治疗的难治性 VF/VT OHCA 成人的生存率（将持续 CPR 转运至心导管实验室进行 ECPR）与 654 名接受标准 CPR 的成人患者相比ALPS 试验。我们评估了与 UMN-ECPR 患者的 CPR 持续时间相关的代谢变化和存活率。结果：总体而言，UMN-ECPR 患者与 ALPS 患者相比，神经功能良好的生存率显着更高（33% 对 23%；p = 0.01）。与 ALPS 患者相比，UMN-ECPR 患者的 CPR 平均持续时间也明显更长（60 分钟与 35 分钟；p < 0.001）。对 CPR 持续时间对神经功能良好生存率影响的分析表明，在每个 CPR 持续时间间隔小于 60 分钟时，UMN-ECPR 患者的神经功能良好生存率显着高于 ALPS 患者；然而，在两组中，较长的 CPR 持续时间与神经系统有利生存率的逐渐下降有关。所有进行 20-29 分钟 CPR (8/8) 的 UMN-ECPR 患者均以神经学良好状态存活，而具有相同 CPR 持续时间的 ALPS 患者存活率为 24% (24/102)。CPR {大于或等于}40 分钟的 ALPS 队列中没有神经功能良好的存活者，而进行 50-59 分钟 CPR 的 UMN-ECPR 患者的神经功能良好存活率为 25% (9/36)，而 19% 的 CPR 为{大于或等于}60 分钟。心肺复苏持续时间大于或等于 60 分钟的 UMN-ECPR 患者死亡或神经功能差的相对风险显着降低，显着的代谢变化包括 pH 值下降、乳酸和 paCO2 增加以及左心室壁增厚，专业心肺复苏术。结论：尽管严重的进行性代谢紊乱，ECPR 与所有 CPR 持续时间少于 60 分钟的神经功能良好存活率改善相关。然而，CPR 持续时间仍然是生存的关键决定因素。