2026 年第 3 期 第 21 卷

体外心肺复苏时效性对患者生存结局的影响

Impact of timeliness of extracorporeal cardiopulmonary resuscitation on patients′ survival outcomes

作者：刘元元1贾明1杜中涛1徐博2李呈龙1刘林田1王粮山1王梦军1侯晓彤1

英文作者：Liu Yuanyuan1 Jia Ming1 Du Zhongtao1 Xu Bo2 Li Chenglong1 Liu Lintian1 Wang Liangshan1 Wang Mengjun1 Hou Xiaotong1

单位：1首都医科大学附属北京安贞医院心脏外科危重症中心，北京100029；2首都医科大学附属北京安贞医院体外循环及机械循环辅助科，北京100029

英文单位：1Cardiac Surgery Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Extracorporeal Circulation and Mechanical Circulatory Support Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：体外心肺复苏；体外膜氧合；启动时间；心脏停搏；置管方式；存活率

英文关键词：Extracorporealcardiopulmonaryresuscitation;Extracorporealmembraneoxygenation;Initiationtime;Cardiacarrest;Catheterizationmethod;Survivalrate

• 摘要：

• 目的 探讨应急时效性优化与体外心肺复苏（ECPR）患者生存结局的相关性，为建立高效ECPR快速反应体系提供循证医学依据。方法 回顾性分析2017年1月至2024年12月在首都医科大学附属北京安贞医院接受ECPR治疗的167例危重症患者临床资料。记录体外膜氧合（ECMO）启动时间（从ECMO团队接到求助电话启动应急流程到ECMO成功启动的时间）、安装地点、置管方式等关键指标，分析其与院内死亡率、撤机成功率等临床结局的关系。结果 167例ECPR患者中院内死亡率为71.9%（120/167），撤机成功率为41.9%（70/167）。在手术室和监护室启动ECMO的时间较短，在急诊启动的时间最长，但差异无统计学意义（P=0.131）。预先置管和经皮穿刺者启动时间明显短于切开和穿刺及切开者（均P<0.05）。院内存活者的启动时间显著短于院内死亡者［30.00（21.00，40.00）min比35.00（26.00，48.00）min］（Z=-2.275，P=0.023）。成功撤机者的启动时间也显著短于未撤机者［30.00（21.00，40.50）min比35.00（28.00，49.00）min］（Z=-2.223，P=0.026）。多因素Logistic回归分析结果显示，置管方式是影响ECPR启动时间的唯一独立危险因素（风险比=2.273，95%置信区间：1.354～3.815，P=0.002）。Logistic回归模型分析结果显示当启动时间≥40 min时，患者死亡风险显著增加、撤机成功率显著降低（均P<0.05）。结论 启动时间是影响ECPR患者预后的关键因素，采用经皮穿刺置管技术、优化启动时间（控制在40 min内）可显著改善患者生存结局。医疗机构应建立专业化ECPR快速反应团队，制定标准化应急流程，提高难治性心脏停搏患者的救治成功率。

• Objective To investigate the correlation between the optimization of emergency timeliness and survival outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR), and to provide evidence-based medical evidence for the establishment of an efficient ECPR rapid response system. Methods The clinical data of 167 critically ill patients who underwent ECPR treatment at Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2024 were retrospectively analyzed. Key indicators including the extracorporeal membrane oxygenation (ECMO) initiation time (the time from the ECMO team receiving the emergency call to start the emergency process to the successful initiation of ECMO), installation location and catheterization method were recorded, and their relationships with clinical outcomes such as in-hospital mortality and weaning success rate were analyzed. Results The in-hospital mortality rate was 71.9%(120/167) and the weaning success rate was 41.9%(70/167) among the 167 ECPR patients. The ECMO initiation time was shorter in the operating room and intensive care unit, and the longest in the emergency department, with no statistically significant difference (P=0.131). The initiation time of pre-catheterization and percutaneous puncture was significantly shorter than that of incision, puncture combined with incision (all P<0.05). The initiation time of in-hospital survivors was significantly shorter than that of in-hospital non-survivors ［30.00(21.00, 40.00)min vs 35.00(26.00, 48.00)min］(Z=-2.275, P=0.023). The initiation time of successful weaning patients was also significantly shorter than that of unsuccessful weaning patients ［30.00(21.00, 40.50)min vs 35.00(28.00, 49.00)min］(Z=-2.223, P=0.026). Multivariate Logistic regression analysis showed that catheterization method was the only independent risk factor affecting ECPR initiation time (hazard ratio=2.273, 95% confidence interval: 1.354-3.815, P=0.002). Logistic regression model analysis showed that when the initiation time was ≥40 min, the risk of death in patients increased significantly and the weaning success rate decreased significantly (all P<0.05). Conclusion Initiation time is a key factor affecting the prognosis of ECPR patients. The application of percutaneous puncture catheterization technology and optimization of initiation time (controlled within 40 min) can significantly improve the survival outcomes of patients. Medical institutions should establish a professional ECPR rapid response team, formulate standardized emergency processes, and improve the rescue success rate of patients with refractory cardiac arrest.