tailieunhanh - Báo cáo y học: " Extracorporeal life support following out-ofhospital refractory cardiac arre"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Extracorporeal life support following out-ofhospital refractory cardiac arrest. | Le Guen et al. Critical Care 2011 15 R29 http content 15 1 R29 KS CRITICAL CARE RESEARCH Open Access Extracorporeal life support following out-ofhospital refractory cardiac arrest 1 1 r- s 1 1 2 3 Morgan Le Guen Armelle Nicolas-Robin Serge Carreira Mathieu Raux Pascal Leprince Bruno Riou Olivier Langeron1 Abstract Introduction Extracorporeal life support ECLS has recently shown encouraging results in the resuscitation of inhospital IH refractory cardiac arrest. We assessed the use of ECLS following out-of-hospital OH refractory cardiac arrest. Methods We evaluated 51 consecutive patients who experienced witnessed OH refractory cardiac arrest and received automated chest compression and ECLS upon arrival in the hospital. Patients with preexisting severe hypothermia who experienced IH cardiac arrest were excluded. A femorofemoral ECLS was set up on admission to the hospital by a mobile cardiothoracic surgical team. Results Fifty-one patients were included mean age 42 15 years . The median delays from cardiac arrest to cardiopulmonary resuscitation and ECLS were respectively 3 minutes 25th to 75th interquartile range 1 to 7 and 120 minutes 25th to 75th interquartile range 102-149 . Initial rhythm was ventricular fibrillation in 32 patients 63 asystole in 15 patients 29 patients and pulseless rhythm in 4 patients 8 . ECLS failed in 9 patients 18 . Only two patients 4 95 confidence interval 1 to 13 were alive at day 28 with a favourable neurological outcome. There was a significant correlation r P between blood lactate and delay between cardiac arrest and onset of ECLS but not with arterial pH or blood potassium level. Deaths were the consequence of multiorgan failure n 43 47 brain death n 10 20 and refractory hemorrhagic shock n 7 14 and most patients n 46 90 died within 48 hours. Conclusions This poor outcome suggests that the use of ECLS should be more restricted following OH refractory cardiac arrest. Introduction Out-of-hospital OH cardiac .