Clinical PaperEmergency cardio-pulmonary bypass in cardiac arrest: Seventeen years of experience☆
Introduction
Cardiac arrest is one of the leading causes of death in the industrialised world.1 Continuous improvements of cardiopulmonary resuscitation (CPR), like early defibrillation, advanced life support by emergency medical service and improved quality of cardiac massage have lead to better survival rates.2, 3, 4 However overall survival to discharge remains poor with only approximately 10%.5, 6, 7
For several years, the concept of extracorporeal maintenance of circulation until restoration of effective cardiac output is under investigation to achieve better outcome for cardiac arrest patients. Emergency cardiopulmonary bypass (E-CPB) is a rare used treatment option for refractory cardiac arrest and the quantity of experiences in this field is low. Case-reports, animal studies and cohort studies show predominantly favourable effects of E-CPB in cardiac arrest.8, 9, 10, 11, 12, 13, 14, 15 The potential advantages of E-CPB include immediate restoration of forward flow, increased coronary perfusion pressure, reduced right ventricular pressure and improved oxygenation. This could lead to more and a faster restoration of spontaneous circulation (ROSC) and possibly shorter duration of cardiac arrest, compared to standard CPR. On the other hand E-CPB is a very invasive procedure and is associated with complications, requires specially trained staff, and is not available in many hospitals.
The aim of this study was to assess feasibility, safety and outcome related data of E-CPB performed in cardiac arrest situations at our department.
Section snippets
Methods
In this retrospective cohort study all cardiac arrest patients treated with E-CPB were analysed. Data from a cardiac arrest registry of all adult patients who were admitted to the Department of Emergency Medicine of a tertiary-care hospital between January 1993 and February 2010 were investigated. The institutional ethical review board has approved this registry, in which the data of all patients were prospectively documented according to the ‘Utstein Style Criteria’.16
Results
During a 17-year period, 3621 patients with cardiac arrest were treated at the department. Emergency cardiopulmonary bypass was performed in 55 (2%) patients (Table 1). Except 3 patients, all of the in-hospital cardiac arrests occurred at the emergency department. For vascular access percutaneous seldinger technique (27 patients) or surgical cutdown (28 patients) was performed. Time intervals are presented in Table 2.
Weaning from E-CPB could be achieved in 14 (25%) cases. Eight (15%) patients
Discussion
Emergency cardiopulmonary bypass (E-CPB) for patients in cardiac arrest admitted to an emergency department is feasible and safe. In this desperate patient population, the survival rate of 15% was rather high. Without use of E-CPB, these patients probably would have died. Although not often performed, the complication rates are low and without additional life threatening risks.
The Department of Emergency Medicine of the Medical University Vienna at the General Hospital is a centre, which
Conclusion
E-CPB in patients with cardiac arrest has shown to be feasible and successful, even if not often used in our department. In this desperate patient population after prolonged cardiac arrest it is a meaningful treatment option, which should be considered more often and earlier. There is an urgent need to develop further the technique, such as to investigate, if it is justified to use E-CPB already out of hospital in ambulances.
Conflict of interest
None to declare.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.05.029.