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The Annals of Thoracic Surgery, Vol 54, 699-704, Copyright © 1992 by The Society of Thoracic Surgeons
JG Hill, PS Bruhn, SE Cohen, MW Gallagher, F Manart, CA Moore, PE Seifert, P Askari and C Banchieri
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% (37/48) had major therapeutic
interventions as compared with 50.0% (67/135) 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.
ARTICLES
Emergent applications of cardiopulmonary support: a multiinstitutional experience
Emanuel Hospital and Health Center, Portland, Oregon.
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