Effect of extracorporeal membrane oxygenation on the prognosis of neurological function in patients with cardiac arrest

doi:10.3877/cma.j.issn.1674-6880.2022.01.006

Abstract

Abstract:

Objective

To explore the influencing factors of extracorporeal membrane oxygenation (ECMO) on the prognosis of neurological function in patients with cardiac arrest (CA).

Methods

A total of 22 patients with CA who were treated with ECMO in the Department of Intensive Care Unit, the Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine from January 2012 to June 2020 were included. After evaluating the cerebral performance category (CPC) scale at discharge, we divided the participants into two groups: 12 cases in the good CPC group (CPC 1-2) and 10 cases in the poor CPC group (CPC 3-5). The general information, causes of CA, underlying diseases, disease severity, CA related conditions, nervous system related conditions, ECMO related conditions, troponin I, albumin and other biochemical indicators were compared between the two groups. Then with binary Logistic regression analysis, we assessed the possible influencing factors of ECMO on the prognosis of neurological function in participants.

Results

Of the 22 CA patients treated with ECMO, 14 were alive at discharge and among them 12 were alive with good neurological function. The poor CPC group has a significantly higher level of troponin I [47.0 (26.8, 80.0) μg/L vs. 13.6 (3.3, 32.6) μg/L, U = 20.000, P = 0.017], and a lower level of albumin [(27 ± 7) g/L vs. (33 ± 6) g/L, t = 2.485, P = 0.022] comparing with the good CPC group. Though the flow rate on the third day of ECMO was higher in the poor CPC group, there was no statistically significant difference between two groups [(3.6 ± 0.8) L/min vs. (3.0 ± 0.7) L/min, t = 2.091, P = 0.050]. In addition, the Logistic regression analysis showed that lower albumin concentration was an independent risk factor for poor neurological prognosis in patients with CA after ECMO treatment [odds ratio (OR) = 0.755, 95% confidence interval (CI) (0.576, 0.990), P = 0.042].

Conclusion

In present study, we found lower albumin concentration was an independent risk factor for poor neurological prognosis in patients with CA after ECMO treatment.

Key words: Cardiac arrest, Extracorporeal membrane oxygenation, Albumin

Guangyong Jin, Menglu Zhou, Mengyuan Diao, Shaosong Xi, Xiaokang Zeng, Qiao Gu, Ying Zhu, Wei Hu. Effect of extracorporeal membrane oxygenation on the prognosis of neurological function in patients with cardiac arrest[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(01): 28-35.

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References 43

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组别	例数	年龄[岁，M（P₂₅，P₇₅）]	性别（例，男/女）	心脏骤停病因（例）			基础情况（例）					病情严重程度（分）
组别	例数	年龄[岁，M（P₂₅，P₇₅）]	性别（例，男/女）	急性心肌梗死	爆发性心肌炎	其他病因	高血压	糖尿病	CHD	慢性肾病	抽烟	APACHE Ⅱ评分	SOFA评分
CPC良好组	12	37.5（27.0，40.0）	5/7	5	6	1	3	2	1	0	1	21 ± 10	11.5 ± 2.5
CPC不佳组	10	62.5（28.0，67.8）	7/3	7	3	0	5	2	2	1	1	25 ± 10	13.8 ± 5.0
t/χ²/U值		45.000	-	2.169			-	-	-	-	-	0.829	1.390
P值		0.339	0.231	0.338			0.378	1.000	0.571	0.455	1.000	0.417	0.180

组别	例数	年龄[岁，M（P₂₅，P₇₅）]	性别（例，男/女）	心脏骤停病因（例）			基础情况（例）					病情严重程度（分）
组别	例数	年龄[岁，M（P₂₅，P₇₅）]	性别（例，男/女）	急性心肌梗死	爆发性心肌炎	其他病因	高血压	糖尿病	CHD	慢性肾病	抽烟	APACHE Ⅱ评分	SOFA评分
CPC良好组	12	37.5（27.0，40.0）	5/7	5	6	1	3	2	1	0	1	21 ± 10	11.5 ± 2.5
CPC不佳组	10	62.5（28.0，67.8）	7/3	7	3	0	5	2	2	1	1	25 ± 10	13.8 ± 5.0
t/χ²/U值		45.000	-	2.169			-	-	-	-	-	0.829	1.390
P值		0.339	0.231	0.338			0.378	1.000	0.571	0.455	1.000	0.417	0.180

组别	例数	心脏骤停相关情况（例）						神经系统相关情况（例）
组别	例数	发生在医院内	发生在医院外	旁观者心肺复苏	可电击心律	ECMO前ROSC	ROSC后再次心脏骤停	0 h意识-昏迷	72 h意识-昏迷	0 h瞳孔直径（mm）	72 h瞳孔直径（mm）
CPC良好组	12	11	1	12	11	9	11	9	5	2.5（1.6，4.8）	2.0（1.5，2.0）
CPC不佳组	10	8	2	7	9	8	6	8	7	2.3（1.4，3.9）	2.0（1.4，2.9）
t/χ²/U值		-		-	-	-	-	-	-	50.000	56.000
P值		0.571		0.078	1.000	1.000	0.135	1.000	0.231	0.525	0.811
组别	例数	ECMO相关情况
组别	例数	建立ECMO耗时（min）	ECMO后体温（℃）	ECMO后脉搏（次/min）	ECMO后呼吸频率（次/min）	ECMO后平均动脉压（mmHg）	初始流量（L/min）	第1天流量（L/min）	第2天流量（L/min）	第3天流量（L/min）	ECMO运行时间（d）
CPC良好组	12	55.0（42.5，69.8）	36.1（35.6，36.6）	83 ± 34	15.0（15.0，16.0）	94.5（69.0，99.8）	3.4 ± 0.8	3.3（3.0，3.8）	3.4 ± 0.8	3.0 ± 0.7	6.0（5.0，8.0）
CPC不佳组	10	49.0（43.8，71.5）	36.0（35.7，36.8）	110 ± 58	15.0（12.8，16.0）	85.5（70.8，100.0）	3.5 ± 0.8	3.2（3.0，3.7）	3.6 ± 0.9	3.6 ± 0.8	7.0（5.8，11.8）
t/χ²/U值		56.500	56.500	1.296	54.500	56.500	0.203	55.500	0.629	2.091	41.000
P值		0.843	0.842	0.218	0.731	0.843	0.840	0.792	0.536	0.050	0.217
组别	例数	并发症情况（例）			其他相关情况				检验指标
组别	例数	腹腔/消化道出血	下肢缺血	脓毒症	使用CRRT（例）	使用IABP（例）	有创机械通气时间（d）	使用去甲肾上腺素（例）	pH值	乳酸（mmol/L）	24 h乳酸清除率（%）
CPC良好组	12	1	0	0	8	5	9±6	9	7.34（7.22，7.50）	9 ± 6	59 ± 28
CPC不佳组	10	3	3	2	9	6	14 ± 6	7	7.41（7.29，7.45）	8 ± 6	38 ± 43
t/χ²/U值		-	-	-	-	-	2.041	-	57.000	0.294	1.390
P值		0.293	0.078	0.195	0.323	0.670	0.054	1.000	0.869	0.772	0.180
组别	例数	检验指标
组别	例数	肌钙蛋白I（μg/L）	总胆红素（μmol/L）	肌酐（μmol/L）	白蛋白（g/L）	血糖（mmol/L）	血钠（mmol/L）	白细胞计数（× 10⁹/L）	血红蛋白（g/L）	血小板计数（× 10⁹/L）	凝血酶原时间（s）
CPC良好组	12	13.6（3.3，32.6）	18.8（13.2，33.0）	117.5（107.0，169.8）	33 ± 6	13.4（8.3，14.6）	144 ± 6	17 ± 6	109 ± 24	176±87	16.4（15.2，21.7）
CPC不佳组	10	47.0（26.8，80.0）	17.8（11.9，26.7）	112.5（102.3，193.3）	27 ± 7	12.4（10.6，16.1）	146 ± 5	15 ± 6	106 ± 28	169±91	24.9（14.6，41.3）
t/χ²/U值		20.000	55.000	58.000	2.485	59.000	0.738	0.756	0.187	0.171	37.000
P值		0.017	0.767	0.921	0.022	0.974	0.469	0.459	0.854	0.865	0.138

组别	例数	心脏骤停相关情况（例）						神经系统相关情况（例）
组别	例数	发生在医院内	发生在医院外	旁观者心肺复苏	可电击心律	ECMO前ROSC	ROSC后再次心脏骤停	0 h意识-昏迷	72 h意识-昏迷	0 h瞳孔直径（mm）	72 h瞳孔直径（mm）
CPC良好组	12	11	1	12	11	9	11	9	5	2.5（1.6，4.8）	2.0（1.5，2.0）
CPC不佳组	10	8	2	7	9	8	6	8	7	2.3（1.4，3.9）	2.0（1.4，2.9）
t/χ²/U值		-		-	-	-	-	-	-	50.000	56.000
P值		0.571		0.078	1.000	1.000	0.135	1.000	0.231	0.525	0.811
组别	例数	ECMO相关情况
组别	例数	建立ECMO耗时（min）	ECMO后体温（℃）	ECMO后脉搏（次/min）	ECMO后呼吸频率（次/min）	ECMO后平均动脉压（mmHg）	初始流量（L/min）	第1天流量（L/min）	第2天流量（L/min）	第3天流量（L/min）	ECMO运行时间（d）
CPC良好组	12	55.0（42.5，69.8）	36.1（35.6，36.6）	83 ± 34	15.0（15.0，16.0）	94.5（69.0，99.8）	3.4 ± 0.8	3.3（3.0，3.8）	3.4 ± 0.8	3.0 ± 0.7	6.0（5.0，8.0）
CPC不佳组	10	49.0（43.8，71.5）	36.0（35.7，36.8）	110 ± 58	15.0（12.8，16.0）	85.5（70.8，100.0）	3.5 ± 0.8	3.2（3.0，3.7）	3.6 ± 0.9	3.6 ± 0.8	7.0（5.8，11.8）
t/χ²/U值		56.500	56.500	1.296	54.500	56.500	0.203	55.500	0.629	2.091	41.000
P值		0.843	0.842	0.218	0.731	0.843	0.840	0.792	0.536	0.050	0.217
组别	例数	并发症情况（例）			其他相关情况				检验指标
组别	例数	腹腔/消化道出血	下肢缺血	脓毒症	使用CRRT（例）	使用IABP（例）	有创机械通气时间（d）	使用去甲肾上腺素（例）	pH值	乳酸（mmol/L）	24 h乳酸清除率（%）
CPC良好组	12	1	0	0	8	5	9±6	9	7.34（7.22，7.50）	9 ± 6	59 ± 28
CPC不佳组	10	3	3	2	9	6	14 ± 6	7	7.41（7.29，7.45）	8 ± 6	38 ± 43
t/χ²/U值		-	-	-	-	-	2.041	-	57.000	0.294	1.390
P值		0.293	0.078	0.195	0.323	0.670	0.054	1.000	0.869	0.772	0.180
组别	例数	检验指标
组别	例数	肌钙蛋白I（μg/L）	总胆红素（μmol/L）	肌酐（μmol/L）	白蛋白（g/L）	血糖（mmol/L）	血钠（mmol/L）	白细胞计数（× 10⁹/L）	血红蛋白（g/L）	血小板计数（× 10⁹/L）	凝血酶原时间（s）
CPC良好组	12	13.6（3.3，32.6）	18.8（13.2，33.0）	117.5（107.0，169.8）	33 ± 6	13.4（8.3，14.6）	144 ± 6	17 ± 6	109 ± 24	176±87	16.4（15.2，21.7）
CPC不佳组	10	47.0（26.8，80.0）	17.8（11.9，26.7）	112.5（102.3，193.3）	27 ± 7	12.4（10.6，16.1）	146 ± 5	15 ± 6	106 ± 28	169±91	24.9（14.6，41.3）
t/χ²/U值		20.000	55.000	58.000	2.485	59.000	0.738	0.756	0.187	0.171	37.000
P值		0.017	0.767	0.921	0.022	0.974	0.469	0.459	0.854	0.865	0.138

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
肌钙蛋白I（μg/L）	0.005	0.012	0.149	0.700	1.005	0.982 ~ 1.028
白蛋白（g/L）	-0.281	0.138	4.132	0.042	0.755	0.576 ~ 0.990

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