集中治療における経皮的人工心肺補助装置の有用性

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  • The outcome of percutaneous cardiopulmonary support system (PCPS) in intensive care

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We have extensively applied percutaneous cardiopulmonary support system (PCPS) in intensive care setting in these 10 years and.review 71 cases of PCPS in our institute between April 1991 and March 2001 to evaluate its impact on patient's outcome. Forty-four cases were men and 27 cases were women. The mean age was 61.5±10.5 year old. We applied PCPS to 29 cases of out-of-hospital (prehospital) cardiopulmonary arrest and 13 of in-hospital (after arrival at ER) cardiopulmonary arrest in order to resuscitate them. Twenty-nine hospitalized patients were with cardiac failure or pulmonary embolism, and 10 patients were under citical percutaneous transluminal angioplasty or postoperative period of open heart surgery. All of these patients underwent PCPS and forty-six of them (64.8%) were successfully weaned from it. Twenty-seven patients (38.0%) reached hospital discharge and overall mortality rate was 59.2%. Thirty-one patients among the 42 deceased were the arrested patients. PCPS has had less impact on the patients with cardiomyopathy and cardiac surgery patinets who had unstable hemodynamics in addition to postresuscitative ones despite its improvement in hardware and application skills like rapid setup, but seemed to improve the outcome of the patients with arrythmia (ventricular fibrillation), acute pulmonary embolism, and myocardial infarction. The PCPS procedure should be more sophisticated to save the patients who could not survive without it. The indication of PCPS is still controversial and will be in evolution. Further study must be required to establish the clinical indication of PCPS more strictly.

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