Non-pulsatile circulatory support in 90 cases.

Survival after cardiac arrest is reportably less than 10%; after cardiogenic shock it is less than 50%; and in failure to wean post-cardiotomy (even with centrifugal pumps in several large series) it is only 11-21%. The authors' experience with non-pulsatile circulatory support in 90 consecutive cases from 1986-91 has shown improved survival. The emergent cardiopulmonary bypass system (CPS) was used in 67 of the 90 patients, with 65 patients resuscitated, 34 (51%) weaned, and 19 (28%) transferred to other cardiovascular support therapies. Of the patients weaned or transferred, 34 (51%) survived > 24 hr, and 21 (31%) survived > 30 days. In the current series, 108 major cardiovascular procedures were done during or after CPS implementation. An in-house trained nursing team working with surgeons and perfusionists contributed to early implementation of the CPS and the subsequent improved survival. The BioMedicus centrifugal pump (VAD) was used predominantly for post-cardiotomy failure to wean in 16 patients and as a bridge to transplant in 7 patients. Fourteen patients (61%) were weaned or transplanted. Of these 14 patients, 11 (48%) survived > 30 days. Non-pulsatile circulatory support devices are relatively inexpensive and available to most hospitals. With careful patient selection and early implementation, one can expect survival of 37% of patients who would otherwise not survive.

Experience and directions using cardiopulmonary support in fifty-three consecutive cases.

Emergency cardiopulmonary support (CPS) was instituted in 53 consecutive patients for acute life threatening pathologies. Indications for CPS deployment were: cardiac arrest, 60% (n = 32); cardiogenic shock, 20.4% (n = 11), supported angioplasty, 13% (n = 7); and adult respiratory distress syndrome, 5.6% (n = 3). Cardiopulmonary support was successfully deployed in 51 of the 53 patients (96%), resulting in a mean blood pressure greater than or equal to 60 mmHg, CO greater than or equal to 3-5 L/min, and partial pressure of oxygen greater than or equal to 100 mmHg, with venous oxygen saturation greater than or equal to 60%. The average time from arrest to CPS deployment was 40 minutes. Seventy-nine major cardiovascular procedures were done in these 51 patients (average, 1.5/patient). The duration of support ranged from 1 to 75 hrs (mean, 16.1 hrs). Twenty-seven patients (53%) were weaned, 13 successfully (32%), with 11 (85%) surviving greater than 24 hrs, and six (46%), greater than 30 days. The other 24 patients (47%) were transferred to other treatment modalities, including cardiac surgery and bridge-to-transplant ventricular assist devices. Four of these patients died (17%), whereas 20 (83%) survived. Of these survivors, 19 (95%) survived greater than 24 hrs, whereas 11 (55%) survived greater than 30 days. The overall survival using the CPS system is 59% short-term (greater than 24 hrs.), and 33% long-term (greater than 30 days). In conclusion, the CPS system is a potent and effective resuscitative tool. It requires transfer to other treatment modalities for survival in most cases.