Factors for Successful Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Low Cardiac Output Syndrome After Cardiovascular Surgery

Abstract

SUMMARYThe objective of this study was to analyze the early predictive factors for successful weaning from a percutaneous cardiopulmonary support system (PCPS) in patients with low cardiac output syndrome after cardiovascular surgery.A total of 938 patients underwent cardiovascular surgery with cardiopulmonary bypass (CPB) from January 1991 to September 2006 at Gunma University Hospital. Of these 938 patients, 13 (1.4%) required PCPS to maintain hemodynamics within 48 hours after surgery. The mean age of the 13 patients was 66 years (range, 45 to 86 years). Nine patients underwent open-heart surgery, 3 repair of a thoracic aortic aneurysm, and 1 a pericardiectomy. The patients were divided into 2 groups; group A (n = 4) who were removed from PCPS and group B (n = 9) who were not removed from PCPS. The conditions during the operation and after PCPS support were compared between the 2 groups.The mean age was higher, and operation time, CPB time, and aortic cross-clamping time were significantly (P < 0.05) longer in patients with PCPS than in those without PCPS. The mean PCPS time in all 13 patients was 190 ± 122 hours. The mean age was higher, and CPB time and the aortic cross-clamping time were longer in group B than in group A (NS). The mean duration of PCPS support was significantly (P < 0.05) shorter in group A than in group B (117 ± 42 hours versus 235 ± 136 hours). PCPS flow in group A could be reduced from 48 hours after PCPS induction. However, PCPC flow in group B could not be reduced, and there were significant (P < 0.05) differences in PCPS flow at 72 and 96 hours after starting PCPS. Significant (P < 0.05) differences in the absolute values of the APACHE II score, serum lactate levels, administered epinephrine dose, and levels of total bilirubin (T-Bil), serum creatinine (sCr), and lactate dehydrogenase (LDH) were found between the 2 groups within 96 hours after PCPS induction. In addition, there were significant (P < 0.05) differences in the rate of change compared with the baseline control value obtained prior to PCPS use in PCPS flow, APACHE II score, and levels of T-Bil, sCr, and LDH within 96 hours after PCPS induction. Significant differences in the rate of change of sCr and LDH were found, especially from the early phase after PCPS use, compared with other parameters.From the

Predictive factors for successful weaning from percutaneous cardiopulmonary support in patients with cardiogenic shock complicating acute myocardial infarction

“…In our study population consisting of patients with AMI, the early reduction of PCPS flow was considered to be important to decrease the afterload and to improve the coronary circulation. Several reports advocated the fundamental concept that the lowest rate of flow that did not induce peripheral circulatory failure should be used and adjusted in accordance with cardiac function after the initial stabilization established by installation of PCPS [24,26,27]. The present PCPS study is consistent with previous reports.…”

“…A low BE indicates metabolic acidosis, and is usually caused by the disturbance of peripheral circulation, renal failure, and lactic acidosis. The deterioration of BE at the start of PCPS in both groups may have been caused by the disturbance of peripheral circulation, therefore, BE levels improved after the start of PCPS even in group B. Serum lactate level is considered a prognostic indicator for patients with cardiogenic shock requiring PCPS, and the increase in serum lactate level is caused by the tissue hypoxia, sepsis, hepatic dysfunction, and multiple organ failure [26,27]. It is possible that lactic acidosis may have occurred in group B during the treatment of PCPS, and BE deteriorated again before the discontinuation of PCPS.…”

“…Weaning from PCPS is often difficult and not always successful due to the complications mentioned above, and therefore, the appropriate discontinuation of PCPS is a critical problem [22,23]. Several reports found that appropriate adjustment of the support flow rate after the initiation of PCPS facilitates the recovery of cardiac function and subsequently contributes to prevent the complications associated with PCPS [24][25][26][27]. To date, there have been no guidelines established for the use of PCPS, nor have methods been established for successful weaning from PCPS.…”

Reduced Number of Platelets During Intra-Aortic Balloon Pumping Counterpulsation Predicts Higher Cardiovascular Mortality After Device Removal in Association with Systemic Inflammation

“…4) In hemodynamically unstable patients with critical cardiovascular disorders who require mechanical circulatory support, such as percutaneous placement of intra-aortic balloon pumping (IABP) counterpulsation, thrombocytopenia is one of the most fre-quent complications, with an incidence range of 20% to 60%. [5][6][7][8] Thrombocytopenia in such patients has been thought to be primarily induced by the mechanical destruction of circulating platelets, and its prognostic impact for short-term adverse outcomes, such as in-hospital allcause death, was previously described. 9) Nevertheless, whether thrombocytopenia in patients with a mechanical circulatory support device predicts long-term cardiovascular events after its removal has not been adequately evaluated.…”