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Average mean arterial pressure in the first 6 hours of extracorporeal cardiopulmonary resuscitation in the prediction of the prognosis of neurological outcome: a single-center retrospective study
Perfusion ( IF 1.2 ) Pub Date : 2021-07-02 , DOI: 10.1177/02676591211027118
Feng Sun 1 , Yong Mei 1 , Jinru Lv 1 , Wei Li 1 , Deliang Hu 1 , Gang Zhang 1 , Huazhong Zhang 1 , Jinsong Zhang 1 , Xufeng Chen 1
Affiliation  

Objective:

To study the correlation between the mean arterial pressure (MAP) level in the first 6 hours of extracorporeal cardiopulmonary resuscitation (ECPR) and patients’ neurological outcomes.

Methods:

Sex, age, basic comorbidities, the time from the first cardiac arrest to the start of CPR, the time from the first cardiac arrest to extracorporeal membrane oxygenation (ECMO), standardized ECMO flow, and the pH value at the beginning of ECMO and after 6 hours were recorded. MAP was recorded every 2 hours during the first 6 hours, and the average was calculated. The lactic acid clearance rate of the first 6 hours was calculated. Evaluated the neurological prognosis of patients at discharge. Then the patients were divided into groups according to their average MAP, and the above variables were compared in groups.

Results:

Enrolled 63 adult ECPR patients. There were no statistically significant differences in sex, age, basic comorbidities, the time from the first cardiac arrest to the start of conventional CPR, the time from the first cardiac arrest to the start of ECMO, standardized ECMO flow, 6-hour lactic acid clearance rate, pH value at the sixth hour of operation between two groups. The pH value at the start of ECMO, survival rate, and good prognosis rate in low average MAP group were significantly lower. Low average MAP was associated with poor neurological outcomes (relative risk (RR) 1.50, 95% CI 1.17, 1.92). The RR of good neurological outcome for patients with average MAP ⩾65 mmHg was 5.91 (95% CI 1.45, 24.06), and the RR for average MAP ⩾100 mmHg was 1.18 (95% CI 0.19, 7.52).

Conclusion:

For ECPR patients, average MAP <65 mmHg in the first 6 hours of ECPR indicates a poor neurological prognosis. However, whether higher average MAP levels can improve the neurological prognosis of ECPR patient remains to be further studied.



中文翻译:

体外心肺复苏前6小时平均动脉压预测神经系统结局预后的单中心回顾性研究

客观的:

研究体外心肺复苏 (ECPR) 前 6 小时内平均动脉压 (MAP) 水平与患者神经功能结局之间的相关性。

方法:

性别、年龄、基础合并症、首次心脏骤停至开始心肺复苏的时间、首次心脏骤停至体外膜肺氧合(ECMO)时间、标准化ECMO流量、ECMO开始时及之后的pH值记录了6个小时。在前 6 小时内每 2 小时记录一次 MAP,并计算平均值。计算前6小时的乳酸清除率。评估患者出院时的神经学预后。然后根据平均MAP对患者进行分组,对上述变量进行分组比较。

结果:

招募了 63 名成年 ECPR 患者。性别、年龄、基础合并症、首次心脏骤停至开始常规CPR时间、首次心脏骤停至开始ECMO时间、标准化ECMO流量、6小时乳酸两组间清除率、操作第6小时的pH值。低平均MAP组ECMO开始时的pH值、存活率、良好预后率均显着降低。低平均 MAP 与不良神经学结果相关(相对风险 (RR) 1.50,95% CI 1.17,1.92)。平均 MAP 65 mmHg 患者的良好神经学结果的 RR 为 5.91(95% CI 1.45, 24.06),平均 MAP 100 mmHg 的 RR 为 1.18(95% CI 0.19, 7.52)。

结论:

对于 ECPR 患者,ECPR 前 6 小时平均 MAP <65 mmHg 表明神经预后不良。然而,较高的平均MAP水平是否可以改善ECPR患者的神经预后还有待进一步研究。

更新日期:2021-07-02
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