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Sheldon E. Cohen
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Ann Thorac Surg 1992;54:699-704
© 1992 The Society of Thoracic Surgeons

Articles

Emergent applications of cardiopulmonary support: A multiinstitutional experience

Jonathan G. Hill, MD*, Pamela S. Bruhn, RN, BSN, Sheldon E. Cohen, MD, Michael W. Gallagher, MD, Frank Manart, MD, Charles A. Moore, MD, Paul E. Seifert, MD, Paul Askari, CCP, Candace Banchieri, CCP

Emanuel Hospital and Health Center, Portland, Oregon, USA

* Address reprint requests to the National Cardiopulmonary Support Registry for Emergent Applications, c/o Dr Jonathan G. Hill, 2800 N Vancouver Ave, Suite 242, Portland, OR 97227.

The use of emergent portable bypass systems is increasing. Because of limited patient use in any one institution, a combined experience can better determine the applicability of these systems. A total of 187 patients from 17 centers were analyzed. Causes leading to bypass initiation were cardiac arrest (125 patients), cardiogenic shock (44), profound hypothermia (7), pulmonary insufficiency (9), and miscellaneous (2). Weaning from bypass was successful in 30.5% (57 patients). Sixty-four patients (34.2%) were transferred to standard bypass or other modes of circulatory assist. Of the total population, 40 patients (21.4%) were alive greater than 30 days. There were no survivors of unwitnessed arrests. Major diagnostic or therapeutic interventions were carried out on bypass in 74.9% of all patients. In survivors, 77.1% ([equation]) had major therapeutic interventions as compared with 50.0% ([equation]) of nonsurvivors. Emergency portable bypass systems can successfully resuscitate and support cardiac hemodynamics, although the underlying causes necessitating bypass remain difficult to correct. When corrective intervention can be performed, there is an increased chance of survival. Unwitnessed arrest, prolonged cardiopulmonary resuscitation, and lack of treatment options are relative contraindications. Appropriate patient selection and early application of these systems should lead to improved survival.




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