Usefulness of Postoperative Percutaneous Cardiopulmonary Support Using a Centrifugal Pump: Retrospective Analysis of Complications

Yamashita, C; Ataka, Kenichi; Azami, Takashi; Nakagiri, Keitaro; Wakiyama, Hidetaka; Okada, Masayoshi

doi:10.1046/j.1525-1594.1999.06282.x

Cited by 13 publications

(13 citation statements)

References 7 publications

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“…The other factors, aortic cross‐clamp time and preoperative cardiac function, that were significant for weaning from PCPS were not significant for hospital mortality. Bleeding during mechanical support is the most frequent complication (11,14) and massive bleeding results in hypovolemia, which in turn causes unstable hemodynamics due to the impaired inflow volume of PCPS; however, factors related to bleeding (re‐exploration and pRBC/FFP transfusion) were not statistically significant in our series. In this study, urine output during the initial 24 h after the institution of PCPS was much higher for hospital survivors than for hospital nonsurvivors.…”

Section: Discussionmentioning

confidence: 53%

“…Although this system is beneficial for maintaining hemodynamic status and visceral perfusion during circulatory collapse and for reducing the right ventricular preload, the indication of PCPS has not achieved worldwide acceptance, especially for postcardiotomy LOS. Moreover, the weaning rates for PCPS and the survival rates vary because of the variety of underlying diseases, and it has been suggested that one of the major factors related to survival is the ability to correct the underlying pathology (3,4,11). Thus, its elective use for patients undergoing high‐risk coronary intervention has demonstrated acceptable results (2,5), though the clinical use of postcardiotomy LOS has been reported to be unsatisfactory, with survival rates ranging from 4% to 30% (3,6–12).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical application of PCPS (2–4) includes elective circulatory support during high‐risk coronary interventions, resuscitative use for patients with cardiogenic shock mainly due to myocardial infarction, myocarditis, pulmonary embolism, cardiopulmonary arrest (CPA) for any reason in the emergency room, and postcardiotomy low cardiac output syndrome (LOS). The results of elective use for high‐risk coronary interventions are favorable (2,5), but the reported outcomes of the emergency use of PCPS have been unsatisfactory in several series (3,6–12). It has been reported that postcardiotomy cardiogenic shock occurs in 2–6% of patients undergoing revascularization and valvular procedures, and approximately 1% or less will require advanced mechanical assistance other than the intraaortic balloon pump (IABP) (8).…”

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confidence: 99%

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Outcome of the Perioperative Use of Percutaneous Cardiopulmonary Support for Adult Cardiac Surgery: Factors Affecting Hospital Mortality

Murashita¹,

Eya²,

Miyatake³

et al. 2004

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Percutaneous cardiopulmonary bypass support (PCPS) has become a widespread standard modality for the treatment of circulatory collapse; however, its clinical use for postcardiotomy low cardiac output syndrome (LOS) has been reported to be unsatisfactory. We reviewed the clinical outcomes of twenty-three patients undergoing cardiac surgery and treated with PCPS. Solitary coronary artery grafting was undertaken for nine patients, while three had concomitant procedures. The remaining patients underwent valvular surgery. The indications for PCPS were preoperative shock in two patients and postcardiotomy LOS or shock in twenty-one patients. All patients except one underwent an intraaortic balloon pump. Sixteen of the twenty-three patients (69.6%) were weaned from PCPS and twelve patients (52.2%) reached hospital discharge. A univariate analysis revealed that risk factors for hospital mortality were age older than seventy years (P = 0.05), PCPS running time (P = 0.017), low cardiac function at the institution of PCPS (P = 0.004), and urine output within the initial 24 h (P = 0.041). The cardiac index (CI) in survivors was improved within 24 h, and eleven of the twelve survivors were weaned off PCPS within 48 h, whereas ten of the twelve nonsurvivors required PCPS for more than 48 h (P = 0.0006). There is little possibility of weaning patients from PCPS who do not show any signs of hemodynamic recovery within 48 h after its institution. Limited use of PCPS within 48 h may be applicable for postcardiotomy patients, but other cardiopulmonary support, such as a left ventricular assist device, may be required when hemodynamic recovery is not obtained within 48 h.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Outcome of the Perioperative Use of Percutaneous Cardiopulmonary Support for Adult Cardiac Surgery: Factors Affecting Hospital Mortality

Murashita¹,

Eya²,

Miyatake³

et al. 2004

Artificial Organs

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“…Percutaneous cardiopulmonary support with a centrifugal pump has been widely utilized in patients with acute cardiac failure, but the mean duration of assist per pump was only 2.2-3.8 days (12)(13)(14). Mean successful pump use for ECLS was 10.5 ± 7.2 days, without any major clinical complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical Results and Pump Analysis of the Gyro Pump for Long‐Term Extracorporeal Life Support

et al. 2013

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Rescuing patients in severe cardiac failure with extracorporeal support remains challenging. The Gyro pump is a centrifugal blood pump and was now used for cardiopulmonary bypass, although it was originally developed for long‐term cardiac assist. Little is known about clinical experiences using this pump. Here, we report on the clinical results of long‐term extracorporeal life support for over 4 days using the Gyro pump with Excelung, a hollow fiber oxygenator coated with silicone and heparin. Seven patients underwent extracorporeal life support with 15 pump and oxygenator combinations. Gyro and Excelung were used for venoarterial extracorporeal support in six patients and for right ventricular support in one patient. Patient characteristics, pump driving conditions, and blood chemistry were obtained retrospectively. All pumps were subsequently disassembled and examined macroscopically, with 6 of 15 pumps also examined by scanning electron microscopy (SEM). The patient mortality rate was 57.1%. Mean duration of support was 10.5 ± 7.2 days per pump and oxygenator combination. Lactate dehydrogenase and aspartate aminotransferase were generally maintained below 1000 and 100 IU/L, respectively, after the first 4 days of pump driving. Thrombi were found in two pumps, one used without anticoagulation and the other driven at a very slow rotational speed. SEM revealed no wear in the male bearings and very low wear and deformation (0.02 ± 0.03 mm) in the female bearings. The combination of Gyro and Excelung may be applicable for long‐term biventricular and right ventricular support, although proper anticoagulation should be administrated to avoid thrombus formation inside the pump.

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“…5,6 Alternate support from ventricular assist devices is necessary when cardiac function does not recover and powerful long-term assistance is needed. 7,8 PCPS provides immediate life-sustaining circulatory and oxygenation support until diagnostic and therapeutic interventions can be initiated.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Cardiopulmonary Support Aids Resuscitation From Sustained Ventricular Tachycardia

Izawa

Katoh

Shiba

et al. 2003

Circ J

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he use of percutaneous cardiopulmonary support (PCPS) with intraaortic balloon pump (IABP) counterpulsation is an effective treatment for acute circulatory failure. We present a rare case of cardiogenic shock caused by sustained left ventricular tachycardia (LVT) and left ventricular apical dyskinesis, which was treated successfully with mechanical circulatory support system. It is sometimes difficult to uncover the immediate causes of life-threatening arrhythmia or LV dysfunction and using a mechanical circulatory support system can provide primary physicians with adequate time to successfully diagnose and treat reversible causes of cardiogenic shock. Case ReportA 67-year-old man was transferred to the intensive care unit (ICU) because of sustained LVT and cardiogenic shock. He had been well until the day of admission when he felt sudden intermittent chest discomfort and nausea. He had a history of hypertension and had been treated with nifedipine and diltiazem for 5 years. There were no symptoms attributable to infectious disease nor a personal or family history of cardiac disease.On arrival at the primary hospital, his blood pressure was 60/23 mmHg and his heart rate was 260 beats/min. Electrocardiography showed sustained monomorphic LVT with a QRS pattern of right-bundle branch block and a superior axis (Fig 1A,B). Medical termination was attempted initially because he was drowsy. The LVT did not respond to intravenous verapamil (10 mg) and lidocaine (100 mg), Circulation Journal Vol.67, December 2003so direct current cardioversion was performed; however, the LVT continued. Cardioversion was attempted several times after the intravenous administration of each of propranolol (2 mg), disopyramide (50 mg) and procainamide (600 mg). Brief episodes of asystole occurred, followed by LVT. Temporary right ventricular pacing was initiated. Coronary angiography showed normal coronary arteries. The patient had to undergo cardiopulmonary resuscitation during transfer to the ICU at our hospital.Upon arrival in the ICU, the patient's cardiac rhythm alternated between LVT and cardiac standstill with ventricular pacing. His lungs were clear and no murmur or extra heart sounds were heard. Chest X-ray was normal. Two-dimensional echocardiography showed diffuse left ventricular (LV) hypokinesis and dyskinesis of the apical wall (Fig 2). His white blood cell count was 17,910/mm 3 , serum creatine kinase was 410 IU/L, magnesium was 2.2 mg/dl, and C-reactive protein was 0.07 mg/dl. PCPS (CAPIOX SX custom pack, Terumo, Tokyo, Japan) was begun immediately through the right femoral artery and vein with extracorporal circulatory support at 3.0 L/min. Under circulatory support, we performed a right ventricular endomyocardial biopsy and found normal myocardium. The IABP was subsequently inserted through the left femoral artery and was set to 1:1 assistance. Anticoagulation therapy was intravenous administration of heparin to achieve an activated coagulation time of 200 s. After these procedures, the patient's hemodynamic status had imp...

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Usefulness of Postoperative Percutaneous Cardiopulmonary Support Using a Centrifugal Pump: Retrospective Analysis of Complications

Cited by 13 publications

References 7 publications

Outcome of the Perioperative Use of Percutaneous Cardiopulmonary Support for Adult Cardiac Surgery: Factors Affecting Hospital Mortality

Outcome of the Perioperative Use of Percutaneous Cardiopulmonary Support for Adult Cardiac Surgery: Factors Affecting Hospital Mortality

Clinical Results and Pump Analysis of the Gyro Pump for Long‐Term Extracorporeal Life Support

Percutaneous Cardiopulmonary Support Aids Resuscitation From Sustained Ventricular Tachycardia

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