Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Experiences with Emergency Percutaneous Cardiopulmonary Support in In-hospital Cardiac Arrest or Cardiogenic Shock due to the Ischemic Heart Disease

허혈성 심질환으로 인해 병원 내에서 발생한 심정지 혹은 심정지 혹은 심인성 쇼크에 있어서의 경피적 심폐 보조장치의 치료 경험

  • Rhee Il (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Kwon Sung-Uk (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Cho Sung Woo (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Gwon Hyeon-Cheol (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Lee Young Tak (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Park Pyo Won (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Park Kay-Hyun (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Lee Sang Hoon (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine) ;
  • Sung Kiick (Cardiac and Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine)
  • 이일 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 권성욱 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 조성우 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 권현철 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 박표원 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 박계현 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 이상훈 (성균관대학교 의과대학 삼성서울병원 심혈관센터) ;
  • 성기익 (성균관대학교 의과대학 삼성서울병원 심혈관센터)
  • Published : 2006.03.01
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Abstract

Background: Percutaneous cardiopulmonary support (PCPS) provides passive support of gas exchange and perfusion, allowing the use of other methods of care for organ recovery, and saves lives of patients with severe cardiopulmonary failure in a wide variety of clinical settings with a minimal risk of bleeding and need for chest re~ exploration. We summarized a single center's experiences with PCPS in patients with cardiogenic shock or cardiac arrest due to the ischemic heart disease. Material and Method: Among the 20 consecutive patients with cardiogenic shock or cardiac arrest from May 1999 to June 2005, Biopump (Medtronic, Inc, Minneapolis, MN) was used in 7 patients and the self-priming, heparin-coated circuit of EBS (Terumo, Japan) was applied to remaining 13 patients. Most of cannulations were performed percutaneously via femoral arteries and veins. The long venous cannulas of DLP (Medtronic inc. Minneapolis, MN) or the RMI (Edwards's lifescience LLC, Irvine, CA) were used with the arterial cannulae from 17 Fr to 21 Fr and the venous cannula from 21 Fr to 28 Fr. Result: The 20 consecutive patients who were severely compromised and received PCPS for the purpose of resuscitation were comprised of 13 cardiac arrests and 7 cardiogenic shocks in which by-pass surgery was performed in 11 patients and 9 ongoing PCls under the cardiopulmonary support. The mean support time on the PCPS was 38$\pm$42 hours. Of the 20 patients implanted with PCPS, 11 patients ($55\%$) have had the PCPS removed successfully; overall, 8 of these patients ($40\%$) were discharged from the hospital in an average surviving time for 27$\pm$17 days after removing the PCPS and survived well with 31$\pm$30 months of follow-up after the procedure. Conclusion: The use of PCPS appears to provide the hemodynamic restoration, allowing the survival of patients in cardiac arrest or cardiogenic shock who would otherwise not survive, and patients receiving PCPS had a relatively long-term survival.

배경: 경피적 심폐 보조장치(PCPS)는 체내의 가스교환과 혈액의 관류를 간접적으로 도와줌으로써, 장기를 회복시키기 위한 다른 치료법의 사용을 용이하게 하고, 여러 다양한 임상 상황에서 출혈의 위험성을 최소화하면서 심각한 심폐부전에 빠진 환자의 생명을 구해준다. 본 저자들은 허혈성 심질환자들에서 발생한 심인성 쇼크 혹은 심정지를 PCPS로 치료한 경험을 보고하고자 한다. 대상 및 방법:1999년 5월부터 2005년 6월까지 발생한 심정지 혹은 심인성 쇼크 환자들을 대상으로 연구가 진행되었고, 환자들 중 7명에서 원심펌프인 Biopump (Medtronic inc., Minneapolis, MN), 나머지 13명에게는 자가 priming이 되는 헤파린-코팅된 EBS (Terumo, Japan)를 사용하였다. 삽관은 모든 환자에서 대퇴동맥과 대퇴 정맥을 통해서 이루어졌으며, 동맥용 케눌라는 17 Fr에서 21 Fr까지, 정맥용은 21 Fr에서 28 Fr까지 의 DLP (Medtronic inc., Minneapolis, MN) 또는 RMI (Edwards lifescienc LLC, Irvine, CA)의 비교적 긴 정맥용 케눌라를 사용하였다. 결과: 소생을 목적으로 PCPS가 시도되었던 총 20명의 환자들 중에서 심정지가 13명이었으며, 심인성 쇼크였던 환자가 7명이었다. 이들 중 11명에서 관동맥 우회술이 시행되었고, 나머지 9명의 환자에서 PCPS한 상태에서 경피적 관동맥 중재술이 시도되었다. 평균 PCPS가동 시간은 38$\pm$42시간이었으며, 총 20명의 환자들 중 PCPS 이탈이 가능하였던 11명($55\%$)의 환자 중 총 8명($40\%$)의 환자가 특별한 합병증 얼이 평균 27$\pm$17일만에 퇴원하였다. 퇴원한 환자는 현재 모두 생존하여 치장 31개월째 외래 추적관찰 중이다. 결론: PCPS를 시행함으로써 혈역학적 회복을 가져옴으로써 다른 방법으로는 살리기 힘들었던 심정지 또는 심인성 쇼크로부터 환자를 구할 수 있고, 일단 회복된 환자들은 장기 생존율을 보인다.

Keywords

References

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