Elsevier

Resuscitation

Volume 84, Issue 3, March 2013, Pages 326-330
Resuscitation

Clinical Paper
Emergency cardio-pulmonary bypass in cardiac arrest: Seventeen years of experience

https://doi.org/10.1016/j.resuscitation.2012.05.029Get rights and content

Abstract

Aim

Emergency cardiopulmonary bypass (E-CPB) is an advanced and rarely used procedure for patients in cardiac arrest that do not regain restoration of spontaneous circulation with standard resuscitation methods. The feasibility, safety and outcome of the intervention with E-CPB in cardiac arrest situations at our department have been evaluated.

Methods

Clinical presentation, time intervals, diagnosis and outcome of all patients who received E-CPB at an emergency department of a tertiary care university hospital were evaluated. Patient charts were reviewed regarding cardiac arrest variables and treatment data of all patients from 1993 to 2010.

Results

E-CPB was performed in 55 patients. Of all patients, 33 (60%) were male and the median age was 32 years (IQR 24–44). In all cases cardiac arrest was witnessed. The first recorded ECG rhythm showed pulseless electric activity in 23 (42%), ventricular fibrillation in 21 (38%) and asystole in 11 (20%) patients. Cardiac arrest occurred out-of-hospital in 33 (60%) patients. The median duration of CPR before performing E-CPB was 86 min (IQR 69–121). The median ‘cannulation’-time was 33 min (IQR 21–45) and the duration on bypass was 311 min (IQR 161–953). Cardiac causes of arrest were found in 19 (35%) patients. Eight patients (15%) survived to 6 months with good neurological outcome.

Conclusion

E-CPB for cardiac arrest is feasible and safe. In this seemingly desperate patient population after prolonged cardiac arrest, we observed a high survival rate of 15%. E-CPB is a meaningful treatment option, which should be considered more often and earlier.

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.

References (31)

Cited by (0)

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.

View full text