Chest
Clinical Investigations in Critical CareEmergency Department Cardiopulmonary Bypass in the Treatment of Human Cardiac Arrest
Section snippets
Materials and Methods
This study was approved by the Human Rights Committee (Institutional Review Board) of Henry Ford Hospital, Detroit. Patients with either out-of-hospital cardiac arrest or emergency department (ED) cardiac arrest that was unresponsive to ACLS therapy were considered for entry into the study. Patients were eligible for enrollment if they met the following criteria: (1) age older than 14 years and younger than 65 years; (2) witnessed cardiac arrest of ≦30 min for age younger than 40 years and <20
Results
Thirteen patients were originally considered for entry into the study. Cannulation was unsuccessful in three of these patients. This cannulation failure was related to inability to advance the venous cannulas in all three patients. Positioning the patient in reverse Trendelenburg position alleviated this problem. Results from the 10 patients who were successfully placed on CPB will be presented. A representative case (case 5 from Table 1) is presented below for illustrative purposes.
Discussion
CPB has been used with success to resuscitate animals in models of prolonged cardiac arrest.11, 12, 13 In a clinically relevant out-of-hospital cardiac arrest scenario in dogs, Levine et al11 demonstrated significant improvement in long-term neurologic outcome in animals treated with CPB vs standard ACLS after 4 min of VF followed by 30 min of CPR. Several groups have studied the clinical role of CPB as a resuscitative tool14, 15, 16, 17, 18, 19, 20, 21, 22 with varying results. The variance in
Conclusion
CPB instituted by EPs is feasible and effective for the hemodynamic resuscitation of cardiac arrest patients unresponsive to ACLS therapy. With increased awareness of the postresuscitation disease and therapy aimed at alleviating ischemia-reperfusion injury on both an organ-specific and total body basis, more success with CPB as a resuscitative tool may be expected.
Acknowledgments
The authors thank all the ED personnel for their support and help in conducting this study and to Roy Eisiminger, CCP, CCT, for his expertise in operating the CPB unit.
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Critical Care Delivery Solutions in the Emergency Department: Evolving Models in Caring for ICU Boarders
2020, Annals of Emergency MedicineCitation Excerpt :In the early 2000s, after the physical space of the ED was upgraded to accommodate the hybrid category 1 high-acuity area, a dedicated consultation team titled the early intervention team was able to assist in delivering focused critical care and optimize early interventions.19 This adoption accommodated interventions such as early initiation of extracorporeal membrane oxygenation for patients in cardiac arrest.34 The original early intervention team physicians were primarily a mix of emergency physicians with specialized training in CCM or a focused interest in CCM, able to prioritize delivering focused early critical care and leave their colleagues to focus on departmental throughput.
Extracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest
2014, ResuscitationCitation Excerpt :These cases were recently reviewed and summarized in Resuscitation 8. The first English language reports of ECLS for refractory cardiac arrest were published in the late 1990s 4,9. In 2000, physicians at the University of Michigan documented their experience with 1000 consecutive patients treated with ECLS for a variety of indications including cardiac arrest and cardiogenic shock as well as the scientific and logistical evolution of their program 1.
Safety and feasibility of prehospital extra corporeal life support implementation by non-surgeons for out-of-hospital refractory cardiac arrest
2013, ResuscitationCitation Excerpt :Current guidelines state that ECLS should be considered where ECLS is readily available and when the time without blood flow is brief and the condition leading to the cardiac arrest is reversible (e.g. accidental hypothermia or drug intoxication), or amenable, to heart transplantation (e.g. myocarditis) or revascularisation (e.g. acute myocardial infarction).2 Improvement of survival was noted with ECLS for in-hospital cardiac arrest (IHCA),3–5 but its use is controversial in OHCA.6,7 A negative effect of prolonged CPR has been reported8,9 and several studies have evaluated the implementation of ECLS at hospital arrival.6,7,10
revision accepted August 20.