Percutaneous Cardiopulmonary Support for High-Risk Angioplasty

Abstract

Treatment of patients with coronary artery disease with severe left ventricular dysfunction (EF less than 25%) presents a special challenge to the health care team. The ability to revascularize coronary artery lesions using percutaneous transluminal coronary angioplasty is limited because of the risk of acute vessel closure, which can result in hemodynamic collapse, myocardial infarction, and the need for emergent coronary bypass surgery. These patients may not survive long enough to undergo emergency open-heart surgery if acute vessel closure occurs. Percutaneous cardiopulmonary support (PCPS), initiated in the catheterization laboratory before coronary revascularization, can provide the hemodynamic support needed to allow the patient to tolerate the high-risk procedure. This article describes the PCPS procedure at Washington Adventist Hospital, Takoma Park, MD, and includes the clinical applications, risks and benefits, and implications for the critical care nurse.

Percutaneous cardiopulmonary bypass for cardiac emergencies

“…Because of micro-and macrovascular changes present in these conditions, cannula selection may be adversely impacted, and if severe enough, cannulation may not be possible. 48 Finally, in patients with a recent cerebrovascular accident, active hemorrhage, a preexisting coagulopathy, or suspected head injury PCPS with a heparin-bonded circuit should be considered, thus allowing less than full systemic heparinization.…”

Cardiopulmonary support during electrophysiological procedures for ventricular tachycardias not haemodynamically tolerated

“…Haemodynamic monitoring with a Swan-Ganz catheter was not necessary. 5 The CPS system used a Medtronic Bio-Medicus centrifugal pump and a Medtronic Maxima Plus oxygenator (Medtronic, St Paul, MN, USA). Femoral cannulation was performed using the standard Seldinger technique with angiographic control of the cannulation site.…”

ECMO Cannulation Controversies and Complications

“…There is much literature that describes percutaneous Seldinger cannulation for the femoral vessels for cardiopulmonary bypass, 10 but more often, this technique is used for closed chest cardiopulmonary support. [11][12][13][14][15] After heparinization and aseptic prep of the groin, the common femoral artery is accessed with a large bore needle and guidewire is passed. Following a stab incision at the base of the wire, dilators of increasing size are serially passed through the vessel until the arterial cannula can be passed.…”