目的 分析体外心肺复苏（extracorporeal cardiopulmonary resuscitation，ECPR）在急诊难治性心脏骤停患者的应用及生存、神经功能预后影响因素。 方法 回顾性分析2021年1月至2024年3月在南方医科大学附属广东省人民医院急诊科实施的61例体外膜肺氧合（extracorporeal membrane oxygenation， ECMO）用于心肺复苏患者的临床资料。总结出院生存率、神经预后良好率、并发症发生率等。并分析生存组与死亡组的影响因素及影响神经预后的因素。 结果 61例患者ECMO撤机成功率55.7%，出院生存率29.5%，神经预后良好率为21.3%，并发症发生率为47.5%。生存组初始心律为可电击心律占比明显高于死亡组；生存组ECMO建立时间、低血流时间、ECMO支持前血乳酸水平均明显低于死亡组；生存组ECMO支持前血pH水平高于死亡组；生存组ECMO支持时间、住ICU时间明显长于死亡组，以上差异有统计学意义（P < 0.05）。初始心律为可电击心律、低血流时间≤ 60 min的患者有更好的神经预后良好率。 结论 体外心肺复苏可为难治性心脏骤停患者提供有效的生命支持。具有可电击初始心律、ECMO支持前较低的血乳酸水平、较高的pH值及较短低血流时间的患者有更好的预后。

Objective To analyze the clinical application of Extracorporeal Cardiopulmonary Resuscitation （ECPR） in patients with refractory cardiac arrest in the emergency department and to investigate the factors affecting survival and neurological outcomes. Methods A retrospective analysis was conducted on the clinical data of 61 patients who underwent Extracorporeal Membrane Oxygenation （ECMO） for cardiopulmonary resuscitation at the emergency department from January 2021 to March 2024. The hospital discharge survival rate， favorable neurological outcome rate， and incidence of complications were summarized. Factors affecting survival and neurological outcomes were also analyzed. Results In a study of 61 patients， the ECMO weaning success rate was 55.7%， the hospital discharge survival rate was 29.5%， the favorable neurological prognosis rate was 21.3%， and the incidence of complications was 47.5%. The proportion of initial cardiac rhythm being shockable was significantly higher in the survival group compared to the mortality group. The ECMO establishment time， low-flow time， and pre-ECMO blood lactate levels were all significantly lower in the survival group than in the mortality group. The pre-ECMO blood pH level was higher in the survival group. The ECMO maintenance time and ICU stay were significantly longer in the survival group than in the mortality group， with all P-values being less than 0.05， indicating statistically significant differences. Patients with an initial shockable cardiac rhythm and low-flow time ≤ 60 minutes had a better favorable neurological prognosis rate. Conclusions Extracorporeal cardiopulmonary resuscitation can provide effective life support for patients with refractory cardiac arrest. Patients with an initial shockable rhythm， lower blood lactate levels and higher pH levels before ECMO support， and shorter low-flow time have a better prognosis.