Regarding: 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.20021
Wei-Zhen Tang, Zhe-Ming Kang, Tai-Hang Liu
{"title":"Regarding: Time to initiation of extracorporeal membrane oxygenation in conventional cardiopulmonary resuscitation affects the patient survival prognosis","authors":"Wei-Zhen Tang,&nbsp;Zhe-Ming Kang,&nbsp;Tai-Hang Liu","doi":"10.1111/joim.20021","DOIUrl":null,"url":null,"abstract":"<p>After a thorough analysis of the study by Ji-Hoon Sim et al., published in the <i>Journal of Internal Medicine</i>, we express our appreciation for their findings that the early initiation of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) significantly improves short- and long-term survival outcomes. The study highlights the critical role of timely ECMO application in enhancing treatment results for patients receiving extracorporeal PCR (ECPR) [<span>1</span>]. Nevertheless, we believe there are several key issues within the study that could impact the interpretation of the results.</p><p>First, the exclusion criteria of the study did not specifically mention whether certain populations that could significantly affect the study conclusions were excluded. These include patients over the age of 75, those with end-stage malignancies, those requiring ongoing life support, patients with cardiac tamponade due to aortic dissection, and those with persistent intracranial hemorrhage or severe brain injury [<span>2</span>]. For instance, elderly patients may have different physiological characteristics and disease risks, which could affect their response to treatment and recovery capabilities compared to younger patients. The overall health status and life expectancy of patients with end-stage malignancies are already severely compromised. If these patients were not properly excluded, their inclusion could lower overall survival rates, thereby affecting the assessment of ECMO efficacy. Patients who required continuous life support prior to cardiac arrest may have a poorer baseline health status, which could influence the accuracy of the study's findings regarding the relationship between the timing of ECMO initiation and survival rates.</p><p>Second, although the study distinguished between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest patients, it did not detail whether key pre-hospital characteristics of OHCA patients were recorded [<span>2</span>]. Such characteristics include the time of collapse, the presence of a witness, bystander CPR, the occurrence of transient return of spontaneous circulation before hospital arrival, initial shockable rhythm, and the interval from collapse to the initiation of CPR. Pre-hospital constraints may delay the start of ECMO, thereby prolonging the duration of low blood flow in patients, affecting organ perfusion and, ultimately, prognosis [<span>3</span>]. Moreover, the ECMO outcomes for OHCA patients may be affected by the quality of emergency medical services and pre-hospital treatment systems. The difficulty of manual CPR during ambulance transport suggests that mechanical CPR before the start of ECMO could yield different survival outcomes. The lack of these data could limit a comprehensive understanding of the pre-hospital situation and resuscitation process for OHCA patients, which is crucial for analysing the impact of the CPR-to-ECMO interval on prognosis.</p><p>Lastly, the study did not mention specific details of post-cardiac arrest care, such as transfusions, ventilator settings, and treatment of infectious complications. These care measures are typically vital components of the comprehensive treatment and management of post-cardiac arrest patients, significantly impacting their recovery and prognosis. Additionally, the study did not record important observational indicators after the start of ECMO care, such as early achievement of mean arterial pressure, therapeutic temperature management, left ventricular ejection fraction post-ECMO, successful weaning from extracorporeal life support, and complications during ECMO, including access site bleeding, limb ischemia, and intracranial hemorrhage. These factors have been proven to be important in affecting ECMO prognosis [<span>4</span>]. In summary, although the conclusions of Ji-Hoon Sim et al.’s study are enlightening, only after further analysis and addressing the aforementioned issues can the credibility and practicality of the study's conclusions be enhanced.</p><p><b>Wei-Zhen Tang</b>: Conceptualization; methodology; validation. <b>Zhe-Ming Kang</b>: Conceptualization; validation; visualization; formal analysis. <b>Tai-Hang Liu</b>: Formal analysis; investigation.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"296 6","pages":"533-534"},"PeriodicalIF":9.0000,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20021","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/joim.20021","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

After a thorough analysis of the study by Ji-Hoon Sim et al., published in the Journal of Internal Medicine, we express our appreciation for their findings that the early initiation of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR) significantly improves short- and long-term survival outcomes. The study highlights the critical role of timely ECMO application in enhancing treatment results for patients receiving extracorporeal PCR (ECPR) [1]. Nevertheless, we believe there are several key issues within the study that could impact the interpretation of the results.

First, the exclusion criteria of the study did not specifically mention whether certain populations that could significantly affect the study conclusions were excluded. These include patients over the age of 75, those with end-stage malignancies, those requiring ongoing life support, patients with cardiac tamponade due to aortic dissection, and those with persistent intracranial hemorrhage or severe brain injury [2]. For instance, elderly patients may have different physiological characteristics and disease risks, which could affect their response to treatment and recovery capabilities compared to younger patients. The overall health status and life expectancy of patients with end-stage malignancies are already severely compromised. If these patients were not properly excluded, their inclusion could lower overall survival rates, thereby affecting the assessment of ECMO efficacy. Patients who required continuous life support prior to cardiac arrest may have a poorer baseline health status, which could influence the accuracy of the study's findings regarding the relationship between the timing of ECMO initiation and survival rates.

Second, although the study distinguished between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest patients, it did not detail whether key pre-hospital characteristics of OHCA patients were recorded [2]. Such characteristics include the time of collapse, the presence of a witness, bystander CPR, the occurrence of transient return of spontaneous circulation before hospital arrival, initial shockable rhythm, and the interval from collapse to the initiation of CPR. Pre-hospital constraints may delay the start of ECMO, thereby prolonging the duration of low blood flow in patients, affecting organ perfusion and, ultimately, prognosis [3]. Moreover, the ECMO outcomes for OHCA patients may be affected by the quality of emergency medical services and pre-hospital treatment systems. The difficulty of manual CPR during ambulance transport suggests that mechanical CPR before the start of ECMO could yield different survival outcomes. The lack of these data could limit a comprehensive understanding of the pre-hospital situation and resuscitation process for OHCA patients, which is crucial for analysing the impact of the CPR-to-ECMO interval on prognosis.

Lastly, the study did not mention specific details of post-cardiac arrest care, such as transfusions, ventilator settings, and treatment of infectious complications. These care measures are typically vital components of the comprehensive treatment and management of post-cardiac arrest patients, significantly impacting their recovery and prognosis. Additionally, the study did not record important observational indicators after the start of ECMO care, such as early achievement of mean arterial pressure, therapeutic temperature management, left ventricular ejection fraction post-ECMO, successful weaning from extracorporeal life support, and complications during ECMO, including access site bleeding, limb ischemia, and intracranial hemorrhage. These factors have been proven to be important in affecting ECMO prognosis [4]. In summary, although the conclusions of Ji-Hoon Sim et al.’s study are enlightening, only after further analysis and addressing the aforementioned issues can the credibility and practicality of the study's conclusions be enhanced.

Wei-Zhen Tang: Conceptualization; methodology; validation. Zhe-Ming Kang: Conceptualization; validation; visualization; formal analysis. Tai-Hang Liu: Formal analysis; investigation.

The authors declare no conflicts of interest.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
关于:在常规心肺复苏术中启动体外膜肺氧合的时间会影响患者的生存预后。
经过对 Ji-Hoon Sim 等人发表在《内科学杂志》(Journal of Internal Medicine)上的研究进行深入分析,我们对他们的研究结果表示赞赏,即在心肺复苏(CPR)期间尽早启动体外膜肺氧合(ECMO)可显著改善短期和长期生存结果。该研究强调了及时应用 ECMO 对提高接受体外 PCR(ECPR)患者治疗效果的关键作用[1]。然而,我们认为该研究中存在几个关键问题,可能会影响对结果的解释。首先,该研究的排除标准没有具体提及是否排除了某些可能对研究结论产生重大影响的人群。这些人群包括 75 岁以上的患者、恶性肿瘤晚期患者、需要持续生命支持的患者、主动脉夹层导致心脏填塞的患者以及颅内持续出血或严重脑损伤的患者[2]。例如,与年轻患者相比,老年患者可能具有不同的生理特点和疾病风险,这可能会影响他们对治疗的反应和康复能力。晚期恶性肿瘤患者的整体健康状态和预期寿命已经受到严重影响。如果不适当地将这些患者排除在外,他们的加入可能会降低总体存活率,从而影响 ECMO 疗效的评估。其次,尽管该研究区分了院外心脏骤停(OHCA)和院内心脏骤停患者,但并未详细说明是否记录了 OHCA 患者院前的关键特征[2]。这些特征包括倒地时间、有无目击者、旁观者心肺复苏、到达医院前是否出现短暂的自主循环恢复、初始可电击心律以及从倒地到开始心肺复苏的时间间隔。院前限制因素可能会延迟 ECMO 的启动,从而延长患者低血流的持续时间,影响器官灌注,最终影响预后[3]。此外,急诊医疗服务和院前治疗系统的质量也会影响 OHCA 患者的 ECMO 治疗效果。救护车转运过程中人工心肺复苏的困难表明,在开始 ECMO 之前进行机械心肺复苏可能会产生不同的生存结果。这些数据的缺乏可能会限制对 OHCA 患者院前情况和复苏过程的全面了解,而这对于分析心肺复苏到 ECMO 的时间间隔对预后的影响至关重要。最后,该研究没有提及心脏骤停后护理的具体细节,如输血、呼吸机设置和感染性并发症的治疗。这些护理措施通常是心脏骤停后患者综合治疗和管理的重要组成部分,对患者的恢复和预后有重大影响。此外,该研究没有记录 ECMO 治疗开始后的重要观察指标,如早期达到平均动脉压、治疗性体温管理、ECMO 后左心室射血分数、体外生命支持的成功断流以及 ECMO 期间的并发症,包括通路部位出血、肢体缺血和颅内出血。这些因素已被证明是影响 ECMO 预后的重要因素[4]。总之,尽管辛智勋等人的研究结论具有启发性,但只有进一步分析并解决上述问题,才能提高研究结论的可信度和实用性:概念化;方法;验证。康哲明:概念化;验证;可视化;形式分析。刘太行:形式分析;调查。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
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.
期刊最新文献
Therapeutic BCG vaccine protects against long COVID: The BATTLE randomized clinical trial. Different ways of diagnosing selective glomerular hypofiltration syndromes such as shrunken pore syndrome and the associated increase in mortality. Statin-associated regulation of hepatic PNPLA3 in patients without known liver disease. Issue Information Association among major adverse cardiovascular events with immune checkpoint inhibitors: A systematic review and meta-analysis.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1