Improved survival after cardiac arrest using emergent autopriming percutaneous cardiopulmonary support.

BACKGROUND

Emergent percutaneous cardiopulmonary support (PCPS) has the potential to rescue patients in cardiac arrest who might otherwise die. We retrospectively reviewed the results of PCPS using preassembled, heparin-coated, and autopriming devices in patients in cardiac arrest.

METHODS

From November 2003 to July 2005, 22 patients in cardiac arrest underwent PCPS using the Capiox emergent bypass system (Terumo, Tokyo, Japan). The mean +/- SD age was 63 +/- 14 (range, 31 to 85) years. In six patients, the underlying disease causing cardiac arrest was not diagnosed before PCPS. The procedure involved 14 to 21 Fr percutaneous femoral arterial cannulae and 17 to 28 Fr percutaneous femoral long venous cannulae. The mean duration of cardiopulmonary resuscitation before PCPS was 48.5 +/- 29.0 (range, 15 to 143) minutes. An intraaortic balloon pump was used concomitantly in six patients.

RESULTS

Fourteen patients received additional surgical or interventional procedures during PCPS. Thirteen (59%) patients could be weaned off PCPS after 52.3 +/- 47.8 (range, 4 to 141) hours of support. Twelve complications occurred in 11 patients, including eight related to PCPS: low perfusion flow (two), gastrointestinal bleeding (two), surgical wound bleeding (one), femoral arterial catheter dislodgement (one), hemolysis with acute renal failure (one), and mitral valve thrombus (one). Nine patients (41%) were discharged from hospital without neurologic complications. The incidence of complications differed in comparisons between patients who survived and did not survive.

CONCLUSIONS

The use of preassembled, heparin-coated and autoprimed devices enabled us to rescue in-hospital cardiac arrest patients who might have died without this procedure.