Non-pulsatile circulatory support in 90 cases

Survival after cardiac arrest is reportably less than 10%; after cardiogenic shock it is less than 50%; and in failure to wean post-cardiotomy (even with centrifugal pumps in several large series) it is only 11-21%. The authors' experience with non-pulsatile circulatory support in 90 consecutive cases from 1986-91 has shown improved survival. The emergent cardiopulmonary bypass system (CPS) was used in 67 of the 90 patients, with 65 patients resuscitated, 34 (51%) weaned, and 19 (28%) transferred to other cardiovascular support therapies. Of the patients weaned or transferred, 34 (51%) survived > 24 hr, and 21 (31%) survived > 30 days. In the current series, 108 major cardiovascular procedures were done during or after CPS implementation. An in-house trained nursing team working with surgeons and perfusionists contributed to early implementation of the CPS and the subsequent improved survival. The BioMedicus centrifugal pump (VAD) was used predominantly for post-cardiotomy failure to wean in 16 patients and as a bridge to transplant in 7 patients. Fourteen patients (61%) were weaned or transplanted. Of these 14 patients, 11 (48%) survived > 30 days. Non-pulsatile circulatory support devices are relatively inexpensive and available to most hospitals. With careful patient selection and early implementation, one can expect survival of 37% of patients who would otherwise not survive.