Efficacy of emergent percutaneous cardiopulmonary support in cardiac or respiratory failure: fight or flight?

Abstract

We retrospectively evaluated early outcome and conducted this study to determine the predictive factors for percutaneous cardiopulmonary support (PCPS) weaning and hospital discharge. From January 2004 to December 2006, 92 patients diagnosed as cardiac or respiratory failure underwent PCPS using the Capiox emergent bypass system (Terumo, Tokyo, Japan). The mean+/-S.D. age was 56+/-18 (range, 14-85) years and 59 (64%) were male. The mean duration of PCPS was 90.9+/-126.0 h and that of cardiopulmonary resuscitation (CPR) was 51.1+/-27.8 min. The rate of weaning was 59/92 (64%) and the rate of survival to discharge was 39/92 (42%). The results indicated that the etiologic disease (myocarditis) and the cause of PCPS (cardiopulmonary arrest) are significantly correlated with weaning, whereas cardiopulmonary arrest and a shorter CPR duration (<60 min) are considerably correlated with survival. On the contrary, elderly patients (>75 years) have similar rates of weaning and survival compared with younger patients. PCPS provides an acceptable survival rate and outcome in patients with cardiac or respiratory failure. Prompt application and selection of patients with a specific disease (myocarditis) provides good results. It is also effective in elderly patients, providing hospital survival similar to that for younger patients.

Usefulness of a Simple Prognostication Score in Prediction of the Prognoses of Patients With Out-of-Hospital Cardiac Arrests

“…2,11,12) Data collection: Prehospital data were collected retrospectively using a data form following the Utstein-style reporting guidelines for cardiac arrests, 10,11) which included information on demographics (age and sex), location of cardiac arrest (home, public space, healthcare facility for the elderly, or ambulance), witnessed cardiac arrest, type of initial cardiac rhythm at scene (ventricular fi brillation [VF] or pulseless ventricular tachycardia [VT], pulseless electric activity [PEA], or asystole), time intervals from the events (from call receipt to arrival at scene, from departure to arrival at scene, from departure to arrival at the hospital, from call receipt to arrival at the hospital), bystander-initiated CPR (includes conventional and chest-compression-only CPR by citizens/EMS providers), defibrillation shock by citizens or EMS providers, epinephrine administration by ELSTs, return of spontaneous circulation (ROSC) before arrival at the hospital, both pupilometers and presence of light refl ex. In-hospital data were collected in accordance with the following list of parameters: the level of consciousness on the Glasgow coma scale (GCS) on arrival, 13) initial cardiac rhythm in hospital, presumed cause of cardiac arrest (cardiac or noncardiac origin), data of blood samples (arterial blood pH, serum K + , C-reactive protein [CRP], total bilirubin, creatinine, blood sugar, lactate, troponin I and brain natriuretic peptide [BNP]) and details of treatment that was performed in our hospital (such as hypothermia therapy, [2][3][4] PCPS 3) and emergency catheterization [emergency or elective percutaneous coronary intervention: PCI]). 14) Blood samples were immediately obtained from the femoral artery upon arrival at the hospital.…”

“…Predictive factors for survival and prognostication score: Although the survival rate has been improved in recent years, the prognoses of patients with cardiac arrest are still limited even by applying more aggressive therapies such as hypothermia therapy 2) and/or PCPS, 3) and emergency PCI. 15) Importantly, the application of these aggressive therapies must be limited due to various factors such as spatial, fi nancial and human limitations, so they cannot be applied for all patients with cardiac arrest.…”

“…1) Although several aggressive therapeutic concepts, such as hypothermia therapy 2) or percutaneous cardiopulmonary support (PCPS), 3) have been proposed, the overall survival rate of out-of-hospital cardiac arrests (OHCAs) is still limited to around 6.3%, 4,5) and is especially poor among patients who showed poor responses to the advanced life support (ALS) procedure provided by paramedical personnel. In the concept of emergency life support, the importance of a 'chain of survival', that is, 4 connected circles of early access, early cardiopulmonary resuscitation (CPR), early defi brillation, and early ALS has been emphasized to decrease the mortality of patients of OHCAs, 4) but the survival of individual patients depends on various factors.…”

Predictive Score for Survival After Percutaneous Cardiopulmonary Support in Cardiovascular Disease Patients

“…1 Therefore, PCPS has been used for severe cardiogenic shock or circulatory collapse complicating acute myocardial infarction, severe heart failure, fulminant myocarditis (FM), pulmonary thromboembolism, and refractory ventricular arrhythmia. 2 Several reports on emergency PCPS use have been published with relatively good results, showing a 20-60% survival rate. 3, 4 Despite major advances, however, in P PCPS Score for Cardiovascular Disease care unit (ICU) of Chiba Hokusoh Hospital, Nippon Medical School between February 2005 and December 2012.…”

“…3, 4 Despite major advances, however, in P PCPS Score for Cardiovascular Disease care unit (ICU) of Chiba Hokusoh Hospital, Nippon Medical School between February 2005 and December 2012. The indications for and the timing of PCPS initiation were determined by the experienced interventional cardiologist in charge, according to the following criteria: (1) severe intractable cardiogenic shock with imminent cardiac arrest (CA) refractory to catecholamine and intra-aortic balloon pumping (IABP) after correcting both hypovolemia, hypoxemia and acidemia; (2) inhospital CA with cardiovascular disease; and (3) out-of-hospital CA with admission to the emergency department within 45 min and no response to the usual advanced cardiovascular life support (ACLS). PCPS was initiated in the catheter laboratory, ICU or emergency department, and was considered to be contraindicated in patients with previous irreversible brain damage or severe comorbidities such as the terminal stage of the early identification of factors associated with a better survival and detailed analysis of the long-term outcomes of survivors are urgently needed.…”