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Improved survival after Hemopump insertion in patients experiencing postcardiotomy cardiogenic shock during
C M Burnett1, J D Vega, B Radovancevic
1Division of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345.
Insights
The Hemopump (HP) ventricular assist device successfully weaned all patients from cardiopulmonary bypass (CPB) when other methods failed. This device offers excellent circulatory support for critical cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Mechanical Circulatory Support
- Critical Care Medicine
Background:
- Coronary artery bypass grafting (CABG) surgery can necessitate cardiopulmonary bypass (CPB).
- Failure to wean from CPB presents a critical clinical challenge.
- Ventricular assist devices (VADs) offer potential solutions for refractory cases.
Purpose of the Study:
- To evaluate the efficacy of immediate Hemopump (HP) placement in patients failing to wean from CPB post-CABG.
- To assess vital organ function, complications, and clinical outcomes associated with HP support.
Main Methods:
- Nine patients with failed weaning from CPB post-CABG received immediate Hemopump (HP) support.
- Hemodynamic parameters, vital organ function (cardiac index, urine output, GCS), and inotropic support were monitored.
- Complications including hemolysis, infection, and limb ischemia were recorded.
Main Results:
- 100% of patients were successfully weaned from CPB with HP support.
- 63.3% of patients were eventually weaned off HP support, with 83.3% of these surviving hospital discharge.
- Survivors showed improved hemodynamic parameters and organ function by 24 hours compared to non-survivors.
- Renal perfusion was maintained even with mean arterial pressures below 60 mmHg.
- No hemolysis, infection, or limb ischemia occurred.
Conclusions:
- The Hemopump is an effective VAD for patients unable to wean from CPB after CABG.
- Early identification of patients requiring significant inotropic support on HP may indicate poor prognosis.
- HP provides safe and effective circulatory support, improving outcomes in complex cardiac surgery cases.
Abstract:
Immediate placement of a Hemopump (HP) ventricular assist device was undertaken in nine patients (seven men, two women) after other attempts at weaning from cardiopulmonary bypass (CPB) after coronary bypass surgery had failed. All nine patients (100%) were successfully weaned from CPB, and six (63.3%) gradually improved enough to permit removal of HP support. Five (83.3%) of the six who were weaned from CPB survived beyond hospital discharge. HP support was evaluated in terms of vital organ function, incidence of complications, and clinical outcome. In both survivors (S) and nonsurvivors (NS), serial hemodynamic measurements were taken. Although there were few differences in hemodynamic parameters between groups at 4 hr, by 24 hr the S group had markedly improved cardiac index, Glasgow Coma Scale, urinary output, and pulse pressure and required far less inotropic support than did the NS group. All four patients who required high dose inotropic agents to maintain acceptable end-organ perfusion on HP support died; three were unable to tolerate weaning from the HP, and all died within 72 hr of surgery because of ineffective myocardial recovery. None of the survivors required additional early inotropic augmentation. Renal perfusion appeared to be well maintained, even with mean arterial pressures below 60 mmHg during HP support. There were no episodes of hemolysis, infection, or limb ischemia in either group. Thus, the Hemopump provided excellent circulatory support for those patients who could not be weaned from CPB by traditional methods.