title: Measurement of end-tidal carbon dioxide in patients with cardiogenic shock treated using a percutaneous cardiopulmonary assist system.
abstract: We have reported that percutaneous cardiopulmonary assist systems (PCPS) are effective in treating life-threatening cardiogenic shock that is intractable to treatment with intraaortic balloon pumping (IABP). However, there are few clinical indices that can be used to evaluate the effectiveness of PCPS. End-tidal carbon dioxide (ET-CO(2)) content reflects pulmonary blood flow. We monitored ET-CO(2) continuously and determined whether we could use it as a new index to evaluate the effectiveness of PCPS. Seventeen patients with cardiogenic shock were intubated and evaluated by ET-CO(2) monitoring during PCPS. The etiology of shock included acute myocardial infarction (n=10), acute myocarditis (n=2), recent coronary artery bypass graft (n=1), cardiac rupture (n=1), hypertrophic obstructive cardiomyopathy complicated by ventricular fibrillation (n=1), left atrial myxoma (n=1) and artificial valve malfunction (n=1). PCPS was extremely effective in 10 of 17 patients (58.8%), and they recovered from the cardiogenic shock. The remaining 7 patients did not recover from shock, and died during PCPS. Six of ten patients who recovered from shock were successfully weaned from PCPS and 4 patients had good long-term survival. In the cases where PCPS was effective, the ET-CO(2) measured soon after the beginning of PCPS was significantly higher than in the cases in which PCPS was ineffective. Furthermore, the ET-CO(2) content increased gradually with the improvement in hemodynamics. In contrast, ET-CO(2) content remained low if PCPS was not effective. The ET-CO(2) represents a useful predictor of survival or death and is also a good index for weaning in patients treated with PCPS.
authors.affiliation: Division of Intensive and Coronary Care Unit, Nippon Medical School. k-tanaka@nms.ac.jp
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Akutsu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fujii
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002245:Carbon Dioxide / Q000097:blood*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide