Chest
Volume 113, Issue 3, March 1998, Pages 743-751
Journal home page for Chest

Clinical Investigations in Critical Care
Emergency Department Cardiopulmonary Bypass in the Treatment of Human Cardiac Arrest

https://doi.org/10.1378/chest.113.3.743Get rights and content

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.

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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