Emergent application of percutaneous cardiopulmonary support system in cardiac arrest patients

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  • 心肺停止症例に対するＰＣＰＳの治療成績

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Abstract

To evaluate the emergent application of percutaneous cardiopulmonary support system (PCPS), we reviewed 43 patients applied with PCPS for refractory cardiac arrest from August 1992 to December 1999. Cardiac arrest occurred outside the hospital (group A) in 9 patients, immediately after the arrival at our emergency department (group B) in 7 patients and after the hospitalization (group C) in 27 patients. The causes of cardiac arrests were acute myocardial infarction in 25, trauma in 4 and pulmonary embolism in 2 patients. Eleven of 43 patients were able to wean successfully from PCPS within two days and seven of eleven survived more than 1 month. Six of seven survivors fully recovered and returned to their usual lives. The ratio of successful weaning from PCPS was 44.4% in group A, 42.9% in group B and 14.8% in group C. The survival ratio was 33.3% in group A, 28.6% in group B and 7.4% in group C. All of the survivors were placed on PCPS within 60 minutes after cardiac arrest. The base excess value of arterial blood gas analysis before the initiation of PCPS was less than -20 mmol/l in all survivors. The site of coronary artery lesion in acute myocardial infarction played a major role in mortality. Excellent survival was noted in patients who had cardiac arrest during cardiac catheterization. In 2 patients fully recovered in group A, bystander CPR began immediately after the cardiac arrest and their initial electrocardiograms showed ventricular fibrillation. The early application of PCPS seems to lead to improved survival in patients with witnessed cardiac arrest who had bystander CPR.

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