Browse > Article

Percutaneous Cardiopulmonary Support (PCPS) for Patients with Cardioppulmonary Bypass Weaning Failure during Open Heart Surgery  

Ryu, Kyoung-Min (Department of Thoracic and cardiovascular Surgery, Dankook University Bundang Hospital)
Park, Seong-Sik (Department of Thoracic and cardiovascular Surgery, Dankook University Bundang Hospital)
Seo, Pil-Won (Department of Thoracic and cardiovascular Surgery, Dankook University Bundang Hospital)
Ryu, Jae-Wook (Department of Thoracic and cardiovascular Surgery, Dankook University Bundang Hospital)
Kim, Seok-Kon (Department of Pain and Anesthesiology, College of Medicine, Dankook University)
Publication Information
Journal of Chest Surgery / v.42, no.5, 2009 , pp. 604-609 More about this Journal
Abstract
Background: Recently, percutaneous cardiopulmonary support (PCPS) has been widely used to rescue patients in cardiogenic shock or cardiac arrest. However, patients with cardiopulmonary bypass (CPB) weaning failure during open heart surgery still have very poor outcomes after PCPS. We investigated clinical results and prognostic factors for patients who underwent PCPS during open heart surgery. Material and Method: From January 2005 to December 2008, 10 patients with CPB weaning failure during open heart surgery underwent PCPS using the CAPIOX emergency bypass system ($EBS^{(R)}$, Terumo Inc, Tokyo, Japan). We retrospectively reviewed the medical records of those 10 patients. Result: The average age of the patients was $60.2{\pm}16.5$ years (range, $19{\sim}77$ years). The mean supporting time was $48.7{\pm}64.7$ hours (range, $4{\sim}210$ hours). Of the 10 patients, 6(60%) were successfully weaned from the PCPS While 5 (50%) were able to be discharged from the hospital. Complications were noted in 5 patients (50%). In univariate analysis, long aortic cross clamp time during surgery, mediastinal bleeding during PCPS and high level of Troponin-I before PCPS were significant risk factors. All of the discharged patients are still surviving $34{\pm}8.6$ months (range, $23{\sim}48$ months) post-operatively. Conclusion: The use of PCPS for CPB weaning failure during open heart surgery can improve the prognosis. More experience and additional clinical studies are necessary to improve survival and decrease complications.
Keywords
Extracorporeal circulation; Postcardiotomy cardiogenic shock; Percutaneous cardiopulmonary support;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 2002; 3:538-45
2 Bakhtiary F, Keller H, Dogan S, et al. Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: Clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg 2008;135:382-8   DOI   ScienceOn
3 Chatzis AC, Giannopoulos NM, Tsoutsinos AJ, Zavaropoulos PN, Kirvassilis GV, Sarris GE. Extracorporeal membrane oxygenation circulatory support after cardiac surgery. Transplant Proc 2004;36:1763-5   DOI   ScienceOn
4 Baird CW, Zuakowski D, Robinson B, et al. Anticoagulation and pediatric extracorporeal membrane oxygenation: impact of activated clotting time and heparin dose on survival. Ann Thorac Surg 2007;83:912-20   DOI   ScienceOn
5 Yap HJ, Chen YC, Fang JT, Huang CC. Combination of continuous renal replacement therapies (CRRT) and extracorporeal membrane oxgenation (ECMO) for advanced cardiac patients. Ren Fail 2003;25:183-93   DOI   ScienceOn
6 Sung K, Lee YT, Park PW, et al. Improved survival after cardiac arrest using emergent autopriming percutaneous cardiopulmonary support. Ann Thorac Surg 2006;82:651-6   DOI   ScienceOn
7 Wu MY, Lin PJ, Tsai FC, Haung YJ, Liu KS, Tsai FC. Impact of preexisting organ dysfunction on extracorporeal life support for non-postcardiotomy cardiopulmonary failure. Resuscitation 2008;79:54-60   DOI   ScienceOn
8 Rastan AJ, Lachmann N, Walther T, et al. Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO). Int J Artif Organs 2006;29:1121-31   DOI
9 Chen YS, Lin JW, Yu HY, et al. Cardiopulmonary resuscitation with assisted extracorporeal lifesupport versus conventional cardiopulmonary resuscitation in adults with in- hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008;372:554-61   DOI   ScienceOn
10 Oshima K, Morishita Y, Hinohara H, Hayashi Y, Tajima Y, Kunimoto F. Factors for weaning from a percutaneous cardiopulmonary support system (PCPS) in patients with severe cardiac failure. Int Heart J 2006;47:575-84   DOI   ScienceOn
11 William DC, Atkin PJ, Dembisky WP, et al. Analysis of clinical trends in a program of emergent ECLS for cardiovascular collapse. ASAIO J 1997;43:65-8
12 Magovern GJ, Simpson KA. Extracorporeal membrane oxygenation for adult cardiac support: the allegheny experience. Ann Thorac Surg 1999;68:655-61   DOI   ScienceOn
13 Jurmann J, Haverich A, Demertzis S, et al. Extracorporeal membrane oxygenation (ECMO): extended indication for artificial support of both heart and lungs. Int J Artif Organs 1991;14:771-4
14 Ryu KM, Kim SH, Seo PW, et al. Initial experience of the emergency bypass system (EBS) for the patients with cardiogenic shock due to an acute myocardial infarction. Korean J Thorac Cardiovasc Surg 2008;41:329-34
15 Fuhrman BP, Hernan LJ, Rotta AT, Heard C, Rosenkranz R. Pathophysiology of cardiac extracorporeal membrane oxygenation. Artif Organs 1999;23:966-9   DOI   ScienceOn
16 Doll N, Kiaii B, Borger M, et al. Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg 2004;77:151-7   DOI   ScienceOn
17 Yamashita C, Ataka T, Azami T, et al. Usefulness of postoperative percutaneous cardiopulmonary support using a centrifugal pump: retrospective analysis of complications. Artif Organs 1998;23:360-5   DOI   ScienceOn
18 Zhang R, Kofidis T, Kamiya H, et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg 2006;30:617-20   DOI   ScienceOn
19 Reardon MJ, Conklin LD, Letsou GV, Safi HJ, Espada R, Baldwin JC. Methods of acute postcardiotomy left ventricular assistance. J Cardiovasc Surg 1999;40:627-31