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Emergency cardiopulmonary bypass support in patients with cardiac arrest in the catheterization laboratory
F A Shawl1, M J Domanski, M H Wish
1Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland 20912.
Insights
Cardiopulmonary bypass can save patients experiencing cardiac arrest in the catheterization lab when advanced cardiac life support fails. Early bypass support improves survival and facilitates critical interventions like angioplasty or bypass surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Cardiac arrest in the catheterization laboratory is often fatal if unresponsive to standard advanced cardiac life support (ACLS).
- Limited options exist for patients with refractory cardiac arrest during cardiac procedures.
- Timely intervention is critical for improving outcomes in these emergent situations.
Purpose of the Study:
- To evaluate the efficacy and outcomes of percutaneously instituted cardiopulmonary bypass (CPB) in patients experiencing cardiac arrest within the catheterization laboratory.
- To assess the role of CPB in stabilizing patients and facilitating subsequent revascularization procedures.
- To determine the survival benefit of early CPB implementation in refractory cardiac arrest cases.
Main Methods:
- Seven patients unresponsive to ACLS following cardiac arrest in the catheterization lab underwent percutaneously instituted CPB.
- CPB was initiated 10-45 minutes after cardiac arrest onset.
- Subsequent interventions included coronary bypass surgery or angioplasty for eligible patients.
Main Results:
- Six of seven patients regained consciousness after CPB initiation, with normalized acid-base balance.
- Four patients survived to follow-up (mean 6 months), remaining asymptomatic or NYHA class 1.
- Successful revascularization was performed in five patients; two unsuitable for revascularization expired.
Conclusions:
- Percutaneously instituted cardiopulmonary bypass can effectively stabilize patients with cardiac arrest in the catheterization laboratory.
- CPB facilitates emergency coronary angioplasty or transfer for coronary bypass surgery.
- Early CPB support significantly improves survival in patients unresponsive to ACLS during catheterization procedures.
Abstract:
Cardiac arrest in the catheterization laboratory is fatal if unresponsive to advanced cardiac life support (ACLS). Seven patients not responding to ACLS following cardiac arrest in the catheterization laboratory underwent percutaneously instituted cardiopulmonary bypass support. Cardiac arrest occurred following abrupt closure postcoronary angioplasty in three patients, during cardiogenic shock in three patients, and during diagnostic angiography in one patient. Cardiopulmonary bypass was instituted 10-45 min (mean, 21 min) following the onset of cardiac arrest. Flows on bypass ranged from 4.0 to 5.2 liter/min. Mean blood pressure ranged from 70 to 110 mm Hg on bypass. Six of the seven patients regained consciousness after the institution of bypass. Acid-base balance was normalized in all patients. Coronary bypass surgery was subsequently performed in three patients and coronary angioplasty in two. Four patients survived. One patient died following coronary bypass surgery. Two patients, who were not suitable candidates for revascularization, expired. Total bypass time was 1.5-8.5 hr (mean, 2.7 hr). At a mean follow-up of 6 months, all four survivors are alive and asymptomatic or NYHA class 1. We conclude that cardiopulmonary bypass support 1) can stabilize patients following cardiac arrest in the catheterization laboratory, 2) can facilitate emergency coronary angioplasty or transfer to the operating room for coronary bypass surgery, and (3) can improve survival in patients unresponsive to ACLS when instituted early following cardiac arrest in the catheterization laboratory.