心肺脳蘇生法としてのＰＣＰＳ―当施設１８年の歩み―

DOI 被引用文献2件 参考文献32件
  • 奈良 理
    札幌医科大学附属病院救急集中治療部・高度救命救急センター
  • 浅井 康文
    札幌医科大学附属病院救急集中治療部・高度救命救急センター

書誌事項

タイトル別名
  • Percutaneous Cardiopulmonary Support System (PCPS) for the Resuscitaion of Out-of-Hospital Cardiopulmonary Arrest Patients: Eighteen Years Experience in an Emergency Department
  • Eighteen Years Experience in an Emergency Department
  • 当施設18年の歩み

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Limits regarding the effectiveness of closed-chest compression as a cardiopulmonary cerebral resuscitation technique have been pointed out, and the use of cardiopulmonary bypass apparatus has been gaining attention as an alternative to this technique. However, the clinical application of these machines in first-aid was not realized until the advancement of certain medical technologies, such as extracorporeal membrane oxygenator, centrifugal pumps, and percutaneous-insertion-enabled cannula of the current percutaneous cardiopulmonary support system. There have been many recent reports of the clinical application of PCPS in cardiac arrest patients. The reports showed very good results. For example, in 1983, Phillips and joint researchers reported that from among five cardiac arrest patients they had saved the lives of three using PCPS. From 1989, Safer and joint researchers began clinical studies of PCPS. In 1992, they reported that, from among 187 cardiac arrest patients they had saved the lives of 40 (21%). In our hospital, PCPS as a resuscitation technique has been applied in out-of-hospital cardiac arrest patients since 1988. We applied PCPS in 156 cases up to March 2005 and, as a result, saved 34 lives (21.2%) and acquired 16 intact survival cases (10.2%). In 1999, we began to attach importance to the idea of comprehensive lifesaving medical services, including PCPS for out-of-hospital cardiac arrest patients. That is, we tried to improve prehospital medical procedures, established a radical treatment system for cardiogenic diseases, and introduced post-resuscitation brain hypothermia therapy. As a result, the PCPS introduction time was remarkably shortened and the lifesaving rate was increased. PCPS as a cardiopulmonary cerebral resuscitation technique has several problems: there is no established standard for PCPS and no definitive evaluation of the technique. However, it cannot be negligible that, since 1999, among the cardiac arrest cases in which ordinary advanced life support was not available, at least 10% were acquired as intact survival cases. As a crucial next step, we will establish a standard for PCPS and examine its prospective usage by examining past cases. It is said that PCPS is a high-cost treatment; however, as a counterbalance, we should consider that other lifesaving costs are included in the cost of out-of-hospital cardiac arrest treatment.

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