IMPROVED PATIENT SURVIVAL AFTER CARDIAC-ARREST USING A CARDIOPULMONARY SUPPORT SYSTEM

A portable cardiopulmonary bypass system that can be rapidly deployed in a nonsurgical setting using nursing staff was used in 38 patients with cardiovascular collapse refractory to ACLS protocol. Percutaneous or cutdown cannulation sites were: femoral vein-femoral artery (n = 18), right internal jugular vein-femoral artery (n = 2), right atrium-ascending aorta (n = 12), or a combination approach (n = 4). Two patients could not be cannulated. Patient diagnoses were pulmonary emboli (n = 3), failed coronauy angioplasty (n = 7), myocardial infarction with cardiogenic shock (n = 5), trauma (n = 7), aortic stenosis (n = 2), postcardiotomy deterioration (n = 10), deterioration after cardiac transplantation (n = 2), cardiomyopathy with shock (n = 1), and ruptured ascending aortic dissection (n = 1). Ninety-five percent of patients (36 of 38) were successfully resuscitated to a stable rhythm. Eight diagnostic procedures (coronary angiography, n = 4; pulmonary angiography, n = 3; and aortography, n = 1) were performed while patients were on cardiopulmonary support. Early deaths resulted from massive hemorrhage (n = 8), inability to cannulate (n = 2), and irreversible myocardial injury (n = 10). Sixty-six percent (24 of 36) of patients successfully cannulated underwent conversion to standard cardiopulmonary bypass with attendant operative procedure or placement of ventricular assist device or total artificial heart. Fifty percent (18 of 36) of patients cannulated were successfully weaned from cardiopulmonary support, and 17% ( 6 36) are long-term survivors. Postweaning deaths resulted from central nervous system failure (n = 8), multisystem failure (n = 3), anemia (n = 1, Jehovah's Witness), peripheral pulmonary emboli (n = 1), support withdrawn (n = 1), and sudden death due to arrhythmia (n = 1). Cardiopulmonary support has salvaged 6 patients in our series of 38 who were not able to be resuscitated by conventional techniques. The cardiopulmonary support system supports patients who have experienced sudden death and allows diagnostic and therapeutic interventions to be applied. Survival is coupled to early implementation and reversibility of the conditions that led to patient death. Cardiopulmonary support is ineffective in late cardiogenic shock resulting from massive myocardial infarction or in trauma patients with uncontrolled hemorrhage. © 1990.