Abstract
-
Objectives
- Cardiopulmonary support has been used to treat the patients with refractory cardiogenic shock since 1950s. In advent of portable system its use has been widened considerably. In this retrospective study, we report our single center experience concerning possible indications, complications and outcomes of percutanous cardiopulmonary support (PCPS)
-
Methods
- From January 2013 to March 2014, we searched the patients who were supported by PCPS system by reviewing the medical records in cardiology department at our Hospital. Infectious organism was limited to what was identified within 2 weeks after weaning of PCPS.
-
Results
- A total of 9 patients were supported by PCPS with CAPIOX CX® system (Terumo inc., Tokyo, Japan) initially for ST-segment elevation myocardial infarction/non ST-segment elevation myocardial infarction in 4 patients, myocarditis in 3 patients, valvular heart disease in 1 patient, and acute respiratory distress syndrome in 1 patient. The mean duration of PCPS support was 79.1±76.6 hours and 5 of them were recovered and discharged alive. All the patients needed transfusions of various forms of blood products. And there was one major stroke and one hyperbilirubinemia in related to PCPS treatment.
-
Conclusions
- PCPS treatment was a valuable means to treat the patients with cardiovascular collapse, but not without costs. Efforts to reduce its associated complications should be made to improve outcomes.
-
Keywords: Percutanous cardiopulmonary support
Table 1.Patient characteristics
Patient No. |
Sex/Age (years) |
Diagnosis |
Risk factors |
Prior Stroke |
CPR |
Rhythm S |
BP before PC (mmHg) |
CPS Clinical outcome |
1 |
M/68 |
STEMI |
HTN, Sm |
– |
– |
NSR |
40 |
Death (cardiogenic) |
2 |
M/55 |
Severe MR |
|
– |
+ |
AFL |
80 |
Recovery |
3 |
M/53 |
Myocarditis |
HTN, Sm |
– |
+ |
IVR |
70 |
Recovery |
4 |
M/58 |
Myocarditis |
HTN |
– |
– |
CAVB |
70 |
Recovery |
5 |
M/81 |
STEMI |
HTN |
– |
+ |
CAVB |
0 |
Death (cardiogenic) |
6 |
F/67 |
ARDS, severe MS |
|
+ |
– |
Afib |
92 |
Death (sepsis) |
7 |
F/72 |
STEMI |
HTN, DM |
+ |
+ |
NSR |
60 |
Death(cardiogenic) |
8 |
M/23 |
Viral myocarditis |
|
– |
– |
NSR |
70 |
Recovery |
9 |
M/74 |
NSTEMI |
HTN, DM, Sm |
– |
+ |
Afib |
70 |
Recovery |
Table 2.PCPS characteristics
Pt. No. |
Type |
Cannulation site, artery |
Arterial catheter |
size, Fr |
Cannulation site, vein |
Venous catheter |
size, Fr |
Initial filter type |
Filter change |
Change time |
PCPS duration |
1 |
VA |
RFA |
Edward Fem-Flex® |
16 |
RFV |
Edward |
18 C |
APIOX CX® |
→ CAPIOX CX® |
19 |
36 |
2 |
VA |
RFA |
〃 |
18 |
RFV |
Edward |
20 |
〃 |
– |
NA |
30 |
3 |
VA |
RFA |
〃 |
18 |
RFV |
BioMedicus multi-stage® |
25 |
〃 |
→ Quadrox® |
68 |
232 |
4 |
VA |
LFA |
〃 |
18 |
RFV |
″ |
25 |
〃 |
→ Quadrox® |
26 |
97 |
5 |
VA |
RFA |
〃 |
18 |
RFV |
″ |
25 |
〃 |
– |
NA |
14 |
|
|
|
|
|
RIJV, |
Medtronic DLP |
®, 17, |
|
|
|
|
6 |
VV |
LFA |
〃 |
16 |
RIJV, RFV |
BioMedicus multi-stage® |
17, 21 |
Quadrox® |
– |
NA |
166 |
7 |
VA |
LFA |
〃 |
16 |
RFV |
BioMedicus multi-stage® |
25 C |
APIOX CX® |
– |
NA |
6 |
8 |
VA |
LFA |
〃 |
16 |
LFV |
〃 |
25 |
〃 |
– |
NA |
93 |
9 |
VA |
LFA |
〃 |
16 |
LFV |
〃 |
25 |
〃 |
– |
NA |
38 |
Table 3.Complications during PCPS
Patient No. |
Comlications |
Renal replacement therapy |
FFP T/F(u) |
RBC T/F(u) |
PLT T/F(u) |
Cryorecipitate (u) |
Cultured organism (blood) |
1 |
bleeding (GI, Resp) |
+ |
16 |
19 |
32 |
12 |
none |
2 |
none |
– |
10 |
10 |
16 |
12 |
none |
3 |
bleeding (GI, access site) |
– |
10 |
7 |
0 |
0 |
none |
4 |
stroke |
– |
0 |
8 |
6 |
0 |
S. epidermidis |
5 |
None |
– |
0 |
2 |
0 |
0 |
none |
6 |
hyperbilirubinemia, pneumothorax |
– |
27 |
17 |
114 |
0 |
none |
7 |
None |
– |
0 |
8 |
0 |
0 |
None |
8 |
None |
– |
4 |
1 |
10 |
0 |
None |
9 |
Cannulation site bleeding |
– |
16 |
20 |
30 |
0 |
K.pneumoniae S.mitis/oralis |
References
- 1. Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954;37:171–85.PubMed
- 2. Jaski BE, Ortiz B, Alla KR, Smith SC, Glaser D, Walsh C, et al. A 20-year experience with urgent percutaneous cardiopulmonary bypass for salvage of potential survivors of refractory cardiovascular collapse. J Thorac Cardiovasc Surg. 2010;139:753–7. e751–2..ArticlePubMed
- 3. Aoyama N, Izumi T, Hiramori K, Isobe M, Kawana M, Hiroe M, et al. National survey of fulminant myocarditis in japan: Therapeutic guidelines and longterm prognosis of using percutaneous cardiopulmonary support for fulminant myocarditis (special report from a scientific committee). Circ J. 2002;66:133–44.ArticlePubMed
- 4. Rhee Il, Gwon Hyeon-Cheol, Choi Jinho, Sung Kiick, Lee Young Tak, Kwon Sung-Uk, et al. Percutaneous Cardiopulmonary Support for Emergency In-Hospital Cardiac Arrest or Cardiogenic Shock. Korean Circulation J 2006;36:11–6.Article
- 5. Cho Sung Soo, Oh Chang-Myung, Jang Ji-Yong, Yu Hee Tae, Bang Woo-Dae, Kim Jung-Sun, et al. Percutaneous Cardiopulmonary Support-Supported Percutaneous Coronary Intervention: A Single Center Experience. Korean Circ J 2011;41:299–303.ArticlePubMedPMC
- 6. Orime Y, Shiono M, Hata H, Yagi S, Tsukamoto S, Okumura H, et al. Clinical Experiences of Percutaneous Cardiopulmonary Support: Its Effectiveness and Limit. Artificial Organs 1998;22:498–501.ArticlePubMed
Citations
Citations to this article as recorded by