Emergency department cardiopulmonary bypass in the treatment of human cardiac arrest.

OBJECTIVE To study the use of emergency department (ED) femoro-femoral cardiopulmonary bypass (CPB) in the resuscitation of medical cardiac arrest patients. DESIGN Prospective, uncontrolled trial. SETTING Urban academic ED staffed with board-certified emergency physicians (EPs). PARTICIPANTS Ten patients with medical cardiac arrest unresponsive to standard therapy. INTERVENTIONS Femoro-femoral CPB instituted by EPs. RESULTS The time of cardiac arrest prior to CPB (mean+/-SD) was 32.0+/-13.6 min. The cardiac output while on CPB was 4.09+/-1.03 L/min with an average of 229+/-111 min on bypass. All 10 patients had resumption of spontaneous cardiac activity while on CPB. Seven of these were weaned from CPB with intrinsic spontaneous circulation. Of these, six patients were transferred from the ED to the operating room for cannula removal and vessel repair while the other patient died in the ED soon after discontinuing CPB. Mean survival was 47.8+/-44.7 h in the six patients leaving the ED. Although these patients had successful hemodynamic resuscitation, there were no long-term survivors. CONCLUSION CPB instituted by EPs is feasible and effective for the hemodynamic resuscitation of cardiac arrest patients unresponsive to advanced cardiac life support therapy. Future efforts need to focus on improving long-term outcome.

[1]  R. Engelman,et al.  Emergency cardiopulmonary bypass in the cardiac surgical unit can be a lifesaving measure in postoperative cardiac arrest. , 1994, Circulation.

[2]  M. Fink,et al.  Multiple Organ Failure Syndrome—Part I: Epidemiology, Prognosis, and Pathophysiology , 1991 .

[3]  J. Frederiksen,et al.  Clinical experience with portable cardiopulmonary bypass in cardiac arrest patients. , 1990, The Annals of thoracic surgery.

[4]  P. Safar,et al.  Cardiac resuscitability with cardiopulmonary bypass after increasing ventricular fibrillation times in dogs. , 1990, Annals of emergency medicine.

[5]  S. Smith,et al.  Improved patient survival after cardiac arrest using a cardiopulmonary support system. , 1990, The Annals of thoracic surgery.

[6]  M. Domanski,et al.  Emergency percutaneous cardiopulmonary bypass support in cardiogenic shock from acute myocardial infarction. , 1989, The American journal of cardiology.

[7]  R. Kloner,et al.  Altered myocardial states. The stunned and hibernating myocardium. , 1989, The American journal of medicine.

[8]  W. Wickemeyer,et al.  Percutaneous cardiopulmonary bypass: application and indication for use. , 1989, The Annals of thoracic surgery.

[9]  W. Shoemaker,et al.  Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. , 1988, Critical care medicine.

[10]  G. Krause,et al.  Brain cell death following ischemia and reperfusion: a proposed biochemical sequence. , 1988, Critical Care Medicine.

[11]  L. Shenkman,et al.  Predicting outcome of inhospital cardiopulmonary resuscitation. , 1988, Critical care medicine.

[12]  R. Nowak,et al.  Cardiopulmonary bypass vs CPR as treatment for prolonged canine cardiopulmonary arrest. , 1987, Annals of emergency medicine.

[13]  S. Kelsey,et al.  Cardiopulmonary bypass after prolonged cardiac arrest in dogs. , 1987, Annals of emergency medicine.

[14]  S. Kelsey,et al.  Cardiopulmonary bypass after cardiac arrest and prolonged closed-chest CPR in dogs. , 1987, Annals of emergency medicine.

[15]  K. Hossmann,et al.  Recovery of integrative central nervous function after one hour global cerebro-circulatory arrest in normothermic cat , 1987, Journal of the Neurological Sciences.

[16]  S. Kelsey,et al.  Neurologic recovery after cardiac arrest: Effect of duration of ischemia , 1985, Critical care medicine.

[17]  R O Cummins,et al.  Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. , 1985, The American journal of emergency medicine.

[18]  J. Darin,et al.  Resuscitation time in ventricular fibrillation--a prognostic indicator. , 1983, Annals of emergency medicine.

[19]  E. Cook,et al.  Survival after Cardiopulmonary Resuscitation in the Hospital , 1983 .

[20]  W C Shoemaker,et al.  Clinical trial of survivors' cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. , 1982, Critical care medicine.

[21]  W. Shoemaker,et al.  Evaluation of the biologic importance of various hemodynamic and oxygen transport variables: Which variables should be monitored in postoperative shock? , 1979, Critical care medicine.

[22]  K. Mattox,et al.  Resuscitation of the moribund patient using portable cardiopulmonary bypass. , 1976, The Annals of thoracic surgery.

[23]  D. Beanlands,et al.  Assisted circulation following myocardial infarction: a review of 25 patients treated before 1971. , 1972, Canadian Medical Association journal.

[24]  J. Kennedy.  The role of assisted circulation in cardiac resuscitation. , 1966, JAMA.

[25]  C. L. Hudson.  Finding our way on a path to the future. , 1966, JAMA.