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J Korean Soc Emerg Med > Volume 19(6); 2008 > Article
Journal of The Korean Society of Emergency Medicine 2008;19(6): 632-640.
Experience with Percutaneous Cardiopulmonary Support in Cardiopulmonary Arrest and Postresuscitation Care
Tae Gun Shin, Jin Ho Choi, Hyoung Gon Song, Yeon Kwon Jeong, Ik Joon Jo
Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. drjij@skku.edu
Percutaneous cardiopulmonary support (PCPS) provides hemodynamic stability under various clinical settings, including cardiopulmonary arrest. We compared a single center's experience with performing PCPS during cardiopulmonary resuscitation (CPR) and post-resuscitation care to evaluate the prognostic factors for survival.
We retrospectively reviewed 83 patients with cardiopulmonary arrest who received PCPS during or within 6 hours of CPR from January, 2004, to December, 2007. Venoarterial bypass systems were used in all cases with femoral cannulation.
The mean duration of CPR was 37.2+/-26.4 min and the mean time interval from CPR to PCPS insertion was 73.1+/-107.9 min. The mean duration of PCPS was 73.4+/-110.6 h. Of the 83 patients, 48 underwent PCPS during CPR before recovery of spontaneous circulation and 35 received PCPS during post-resuscitation care for hemodynamic support. Forty-eight patients (57.8%) were successfully weaned off of the PCPS and 34 patients (41.0%) were discharged from the hospital. Among the survivors, 29 patients (34.9%) had no neurological deficits. In multivariate regression analysis, the duration of CPR and defibrillation of pulseless ventricular tachycardia or fibrillation before PCPS were significant prognostic factors for survival (p=0.007 and p=0.015, respectively). In subgroup analysis of the 48 patients who received PCPS before resuscitation with conventional CPR, the duration of CPR that was equal to the time interval from CPR to PCPS insertion was also a significant factor for survival (p=0.011) with a survival rate of 27.1%.
The duration of CPR is very important for survival. Application of PCPS in CPR can shorten the duration of CPR and maintain hemodynamic stability. Therefore, PCPS is a good resuscitative tool in CPR and post-resuscitation care with an acceptable survival rate and outcome when conventional measures fail.
Key words: Cardiopulmonary resuscitation, Cardiopulmonary bypass, Heart arrest, Advanced cardiac life support
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