Aims

Although extracorporeal cardiopulmonary resuscitation (ECPR) improves survival outcomes in refractory cardiac arrest, morbidity and mortality remain significantly high. Information on causes of death in ECPR is limited; however, some evidence suggests withdrawal of life sustaining therapy (WLST) is a major factor in ECPR-associated mortality. We sought to describe the patients experiencing WLST after ECPR.

Methods

The international Extracorporeal Life Support Organization (ELSO) Registry was retrospectively queried for patients more than 18 years old supported with ECPR who underwent WLST due to family request from 2007 to 2017. These patients were split into groups for descriptive and multivariable analysis: early (WLST < 72 hours from cannulation) and routine WLST.

Results

Overall, 411 ECPR patients experienced WLST (median age 42 years IQR = 28–51; 31.7% female) over the 10-year period. 55.5% (n = 228) underwent early WLST with a median ECPR duration of 24 hours (IQR = 7–48) versus routine WLST (median = 147 hours; IQR = 105–238). In multivariable regression analysis, lower arterial blood gas pH (aOR = −3.1; 95% CI = 2.18–2.8; p = 0.04), arterial oxygen saturation (aOR = 1.12; 95% CI = 1.01–1.23; p = 0.02), and higher peak inspiratory pressure (aOR = 0.84; 95% CI = 0.71–1.00; p = 0.05) were independently associated with early WLST. Early WLST patients experienced higher rates of all ECMO-related complications except for infections.

Conclusions

More than half of ECPR patients experienced early WLST within 72 hours. The patients with early WLST had worse markers of severe critical illness at 24 hours and experienced higher rates of complications. Further research should include an appropriate control group to better adjust confounders for ECPR-associated death and focus on prognostication.

中文翻译：

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体外心肺复苏 (ECPR) 中生命维持治疗的早期退出：来自体外生命支持组织登记的结果

目标

尽管体外心肺复苏 (ECPR) 改善了难治性心脏骤停的生存结果，但发病率和死亡率仍然很高。ECPR 中的死因信息有限；然而，一些证据表明，停止生命维持治疗 (WLST) 是 ECPR 相关死亡率的主要因素。我们试图描述在 ECPR 后经历 WLST 的患者。

方法

对 2007 年至 2017 年因家人要求接受 WLST 的 18 岁以上接受 ECPR 支持的患者进行了国际体外生命支持组织 (ELSO) 登记。这些患者被分成几组进行描述性和多变量分析：早期 (WLST < 插管后 72 小时）和常规 WLST。

结果

总体而言，411 名 ECPR 患者在 10 年期间经历了 WLST（中位年龄 42 岁 IQR = 28-51；31.7% 女性）。55.5% ( n  = 228) 接受早期 WLST，中位 ECPR 持续时间为 24 小时 (IQR = 7-48)，而常规 WLST (中位数 = 147 小时；IQR = 105-238)。在多变量回归分析中，降低动脉血气 pH 值（aOR = -3.1；95% CI = 2.18–2.8；p  = 0.04），动脉血氧饱和度（aOR = 1.12；95% CI = 1.01–1.23；p  = 0.02），和更高的吸气峰压（aOR = 0.84；95% CI = 0.71-1.00；p  = 0.05）与早期 WLST 独立相关。除感染外，早期 WLST 患者的所有 ECMO 相关并发症的发生率均较高。

结论

超过一半的 ECPR 患者在 72 小时内经历了早期 WLST。早期 WLST 患者在 24 小时内有更严重的危重疾病标志物，并且并发症发生率更高。进一步的研究应包括一个适当的对照组，以更好地调整 ECPR 相关死亡的混杂因素并关注预后。