The Therapeutic Strategy Introducing "Pre-hospital PCPS Order" System Into Out-of-hospital Cardiogenic Cardiopulmonary Arrest

DOI 3 Citations 10 References
  • Kano Hitoshi
    Emergency and Critical Care Center, Sapporo General Hospital Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Makise Hiroshi
    Emergency and Critical Care Center, Sapporo General Hospital
  • Matsubara Izumi
    Emergency and Critical Care Center, Sapporo General Hospital
  • Itou Yasushi
    Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Nara Satoshi
    Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Asai Yasufumi
    Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Satou Katsuhiko
    Division of Cardiovascular Medicine, Hokko Memorial Hospital

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  • 心原性院外心肺停止患者に対する“ｐｒｅ－ｈｏｓｐｉｔａｌ　ＰＣＰＳ　ｏｒｄｅｒ”システムを導入した治療戦略

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Abstract

In 1991, we introduced percutaneous cardio-pulmonary support (PCPS) at our hospital as a way to conduct aggressive cardiopulmonary cerebral resuscitation for patients with out-of-hospital cardiopulmonary arrest, but the system under which the decision to apply PCPS is made at the hospital and preparations then made could exceed the time limitations imposed for cerebral resuscitation. Thus, we have collaborated with the physician-manned ambulance system, which has been in operation since 1995, and in April 2000 introduced a pre-hospital PCPS order treatment strategy for patients with out-of-hospital cardiogenic cardiopulmonary arrest, who do not respond to drug administration or electrical cardioversion. Under this system, PCPS is aggressively and rapidly instituted by having the physician-manned ambulance initiate the PCPS order and initiate hospital preparations for PCPS. In 13 patients treated under the pre-hospital PCPS order system, the mean time elapsed from arrival at the hospital until initiation of PCPS was 18.8min, and the minimum was 8min. In 45 patients for whom the decision to initiate PCPS was made at the hospital (in-hospital order), the mean time from arrival until initiation of PCPS was 43.7min. The outcome under the pre-hospital order system was full recovery in 5 patients, complete disability in 2 patients, and death in 7 patients, so the proportion achieving full recovery was 38.5% better than 13.3% in 45 patients treated under the in-hospital order system. In cardiopulmonary cerebral resuscitation, rapid return of stable cerebral circulation is critical for determining survival and functional prognosis. We believe that our system in which the physician-manned ambulance monitors the response to drug administration and electrical cardioversion and initiates the order to prepare for PCPS at the hospital is the most sensible treatment strategy to achieve a rapid return of stable cerebral circulation in cardiopulmonary cerebral resuscitation.

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