Journal of Internal Medicine最新文献

The article by Sim et al. [1] in the Journal of Internal Medicine emphasized the critical role of timely ECMO application in optimizing outcomes for patients undergoing ECPR. While recognizing the careful work and valuable contributions of this study, there are some constructive suggestions for future advancement.

First, although the study accounted for various adjustment factors, it may have overlooked some potential influencing variables, such as patient comorbidities or changes in treatment protocols following ECMO initiation. These factors could affect the reliability and validity of the study's results [2].

Second, in the study, the Cox proportional hazards assumption may be violated for several reasons: time dependency: If the effect of ECMO initiation on survival varies over time, it breaches the assumption that hazard ratios remain constant throughout the study period; sample heterogeneity: Variability in patient characteristics within the sample may cause fluctuations in hazard ratios, thus violating the proportionality assumption; lack of testing: Without assessing the proportional hazards assumption using methods like Schoenfeld residuals, undetected violations could compromise the model's validity. Addressing these issues is crucial for ensuring the robustness and accuracy of the Cox regression analysis [3].

Third, the study primarily focuses on short-term outcomes (e.g., 30 days, 90 days, and 6 months), and there may be insufficient assessment of long-term survival and quality of life [4]. It is recommended that future research includes extended follow-up periods to obtain more comprehensive prognostic information.

In conclusion, the results of this study emphasize that the early initiation of ECMO during ECPR significantly improves short- and long-term overall survival outcomes. It highlights the need for prospective, multi-center research, long-term follow-up, standardized protocols, and optimization of procedures to improve clinical practices and patient survival.

Xiao Liu: Conceptualization; methodology; writing—original draft; validation. Bo Liu: Writing—review and editing. Minli Yang: Methodology; supervision. Liu Yang: Methodology; writing—review and editing. Jun Wang: Writing—review and editing; supervision.

The authors declare no conflicts of interest.

Dear Editor,

We read with great interest the article by Sim et al. [1] published in the Journal of Internal Medicine. The authors conducted a retrospective study involving 198 patients to examine the impact of extracorporeal membrane oxygenation (ECMO) initiation timing during routine cardiopulmonary resuscitation (CPR) on patient survival prognosis. The study's findings underscore the crucial role of ECMO in routine CPR, particularly highlighting that an early initiation of ECMO significantly enhances patient survival outcomes. We commend the authors for optimizing the timing of ECMO initiation in clinical practice. However, several aspects warrant further discussion.

First, the article selectively analysed patients who received ECMO but did not provide detailed information regarding the exclusion and selection criteria. For instance, there is no clear explanation of how patients with severe comorbidities or a higher risk of death were managed. This omission could result in a non-representative sample, potentially affecting the generalizability of the study's conclusions.

Second, the article inadequately addresses the neurological prognosis of the patients, as it fails to include data on their long-term neurological outcomes post-discharge (after 3 or 6 months). Given that neurological recovery following cardiac arrest may take an extended period [2], this limitation hinders a comprehensive understanding of the patient's long-term prognosis.

Third, although the article focuses on the timing of ECMO initiation, it does not analyse other concurrent treatments (e.g., high-quality CPR, medications, and temperature management) compared to ECMO. This omission prevents a clear delineation of ECMO's unique contribution relative to other interventions throughout the treatment process [3].

In conclusion, we appreciate the authors for highlighting the significance of timely ECMO initiation during CPR to improve patient survival. This work will raise healthcare professionals’ awareness of the critical importance of early ECMO initiation and contribute to the rapid advancement of this field.

Zegang Ruan: Methodology; writing—original draft; investigation. Yuhao Gan: Methodology; writing—original draft; investigation. Chenyang Xu: Writing—review and editing; supervision.

The authors declare no conflicts of interest.