Authors reply: Time to initiation of extracorporeal membrane oxygenation in conventional cardiopulmonary resuscitation affects the patient survival prognosis

IF 9 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Internal Medicine Pub Date : 2024-10-24 DOI:10.1111/joim.20023
Sang-Wook Lee, Ji-Hoon Sim
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OHCA patients often face more challenges that can delay extracorporeal membrane oxygenation (ECMO) initiation, and in our data, these factors were associated with a poorer prognosis compared to IHCA patients. In future research, it would be advantageous to analyse OHCA patients separately from IHCA patients using a larger dataset to derive clearer insights on these issues.</p><p>Third, we would like to comment on the issues raised by the authors regarding the specific details of post-cardiac arrest care. We agree that various post-cardiac arrest interventions—such as blood transfusions, ventilator settings, treatment of infectious complications, and therapeutic temperature management—as well as complications occurring during ECMO, such as insertion site bleeding, limb ischemia, and intracranial hemorrhage, are critical factors that impact the prognosis of cardiac arrest patients [<span>7, 8</span>]. 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Abstract

We appreciate the opportunity to respond to the three Letters to the Editor [1-3] commenting on our article [4], published in the Journal of Internal Medicine. We have carefully discussed them with the respective authors. We want to express our sincere gratitude for their interest in our work and for the valuable suggestions they have provided.

First, we would like to address the concern raised in all three letters regarding the absence of clear exclusion criteria for comorbidities in our study group [4, 5]. We fully acknowledge and agree with the points raised by the authors of the letters. Although we share their concerns, our study was based on a retrospective data analysis. Consequently, we opted to address these effects by applying statistical corrections in a multivariate analysis rather than excluding them from our study altogether. We agree that in future prospective studies on this topic, it is indeed crucial to thoroughly consider and incorporate multiple factors that may influence patient outcomes into the exclusion criteria.

Second, we would like to address their comments regarding the significant prehospital characteristics of out-of-hospital cardiac arrest (OHCA) patients highlighted in the study. We concur with the authors that there are numerous factors specific to OHCA patients, as opposed to in-hospital cardiac arrest (IHCA) patients, that can influence outcomes [6]. Indeed, it may be more effective to analyse OHCA patients separately from IHCA patients to reach more definitive conclusions. OHCA patients often face more challenges that can delay extracorporeal membrane oxygenation (ECMO) initiation, and in our data, these factors were associated with a poorer prognosis compared to IHCA patients. In future research, it would be advantageous to analyse OHCA patients separately from IHCA patients using a larger dataset to derive clearer insights on these issues.

Third, we would like to comment on the issues raised by the authors regarding the specific details of post-cardiac arrest care. We agree that various post-cardiac arrest interventions—such as blood transfusions, ventilator settings, treatment of infectious complications, and therapeutic temperature management—as well as complications occurring during ECMO, such as insertion site bleeding, limb ischemia, and intracranial hemorrhage, are critical factors that impact the prognosis of cardiac arrest patients [7, 8]. Unfortunately, our study lacked sufficient data in this area to present detailed results. We recognize that detailed descriptions of these post-cardiac arrest treatments and complications may be crucial in understanding the prognosis of ECPR patients, and future studies should include these details and better assess their impact on outcomes.

Finally, we would like to respond to the point raised by the authors regarding the insufficient evaluation of long-term outcomes beyond 6 months [6]. To include as many ECPR patients as possible in our study, we analysed data from patients who had recently undergone ECPR, resulting in a relatively short observation period of about 6 months. We agree that this short observation period may have limited our ability to assess long-term outcomes beyond 6 months. In future studies, we believe that it would be highly valuable to analyse patient outcomes over a longer follow-up period of 1 year or more.

Despite the many limitations pointed out by the authors, we believe our study is significant in highlighting the importance of timely ECMO intervention in patients with cardiac arrest. We are confident that as more data on ECPR become available, higher quality analyses will help clarify some of the unknowns.

Finally, we would like to express our deepest gratitude to the reviewers for their interest in our research and their valuable advice.

Sang-Wook Lee: Writing—original draft; conceptualization; writing—review and editing; investigation. Ji-Hoon Sim: Writing—review and editing.

The authors declare no conflicts of interest.

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作者回复:在常规心肺复苏中启动体外膜肺氧合的时间会影响患者的生存预后。
我们很高兴有机会对发表在《内科学杂志》上的三封评论我们的文章[4]的致编辑信[1-3]做出回应。我们与相关作者进行了认真讨论。首先,我们想回应三封来信中提出的关于我们的研究小组缺乏明确的合并症排除标准的担忧[4, 5]。我们完全承认并同意作者们在信中提出的观点。虽然我们也有同感,但我们的研究是基于回顾性数据分析。因此,我们选择在多变量分析中应用统计校正来解决这些影响,而不是将其完全排除在我们的研究之外。我们同意,在未来有关该主题的前瞻性研究中,将可能影响患者预后的多种因素全面考虑并纳入排除标准确实至关重要。其次,我们想谈谈作者对研究中强调的院外心脏骤停(OHCA)患者院前重要特征的看法。我们同意作者的观点,即与院内心脏骤停(IHCA)患者相比,院外心脏骤停患者有许多特殊因素会影响预后[6]。事实上,将 OHCA 患者与 IHCA 患者分开分析可能会更有效,从而得出更明确的结论。与 IHCA 患者相比,OHCA 患者往往面临着更多的挑战,这些挑战可能会延迟体外膜肺氧合(ECMO)的启动,在我们的数据中,这些因素与较差的预后相关。在未来的研究中,最好使用更大的数据集将 OHCA 患者与 IHCA 患者分开分析,以便更清楚地了解这些问题。第三,我们想就作者提出的有关心脏骤停后护理具体细节的问题发表评论。我们同意,心脏骤停后的各种干预措施,如输血、呼吸机设置、感染性并发症治疗和治疗性体温管理,以及 ECMO 期间发生的并发症,如插入部位出血、肢体缺血和颅内出血,都是影响心脏骤停患者预后的关键因素[7, 8]。遗憾的是,我们的研究在这方面缺乏足够的数据,无法提供详细的结果。我们认识到,详细描述这些心脏骤停后的治疗和并发症可能对了解 ECPR 患者的预后至关重要,未来的研究应包括这些细节,并更好地评估它们对预后的影响。最后,我们想对作者提出的关于 6 个月后长期预后评估不足的观点做出回应[6]。为了将尽可能多的 ECPR 患者纳入我们的研究,我们分析了近期接受 ECPR 的患者的数据,因此观察期相对较短,约为 6 个月。我们同意,较短的观察期可能限制了我们评估 6 个月后长期结果的能力。在未来的研究中,我们认为对患者进行 1 年或更长时间的随访结果分析将非常有价值。尽管作者指出了许多局限性,但我们认为我们的研究在强调对心脏骤停患者进行及时 ECMO 干预的重要性方面意义重大。我们相信,随着 ECPR 数据的不断增加,更高质量的分析将有助于澄清一些未知问题。最后,我们对审稿人对我们研究的关注和提出的宝贵意见深表感谢。Sang-Wook Lee:写作-原稿;构思;写作-审阅和编辑;调查。Ji-Hoon Sim:作者声明无利益冲突。
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来源期刊
Journal of Internal Medicine
Journal of Internal Medicine 医学-医学:内科
CiteScore
22.00
自引率
0.90%
发文量
176
审稿时长
4-8 weeks
期刊介绍: JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.
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