title: Factors for weaning from a percutaneous cardiopulmonary support system (PCPS) in patients with severe cardiac failure: a comparative study in weaned and nonweaned patients.
abstract: The percutaneous cardiopulmonary support system (PCPS) has been widely accepted for the treatment of patients with severe cardiac failure. This system, which uses Seldinger's method through a percutaneous approach, enables rapid application in emergency situations. However, the indication for deployment and discontinuation of PCPS has not yet been established. We evaluated the results of PCPS use for the treatment of patients with severe cardiac failure and investigated factors that would predict successful weaning from PCPS. A total of 32 patients (23 men and 9 women) who had PCPS for the treatment of severe cardiac failure between January 1997 and October 2004 were retrospectively reviewed. The mean age of the patients was 57 +/- 17 years (range, 14 to 78 years). PCPS was necessary for severe cardiac failure after cardiac surgery in 15 patients, pulmonary infarction in 4, acute myocardial infarction in 3, acute myocarditis in 3, and other causes in 7. The mean duration of PCPS support in all 32 patients was 134 +/- 117 hours (range, 8 to 532). Twelve patients (38%) could be weaned from PCPS (group A), while the remaining 20 patients (62%) could not (group B). The incidence of cardiac arrest prior to PCPS use (n = 10, 31%) was significantly (P < 0.05) lower in group A (1/12, 8%) than in group B (9/20, 45%). There were significant differences in the APACHE II scores, urine output, serum lactate levels, and epinephrine and dopamine dose received from PCPS induction to 72 hours after PCPS use between the 2 groups (P < 0.05). Multivariate logistic regression analysis showed that an episode of cardiac arrest prior to PCPS induction was the only significant predictor for the unsuitability for discontinuation of PCPS. This retrospective study showed the limitation of PCPS therapy for patients with an episode of cardiac arrest who did not show improvement in their APACHE II score, urine output, serum lactate levels, and catecholamine dose received within 72 hours after PCPS induction. These results may help formulate criteria for indication and discontinuation of PCPS for patients with severe cardiac failure.
authors.affiliation: Intensive Care Unit, Gunma University Hospital, Gunma, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Oshima
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hinohara
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tajima
authors.forename: Fumio
authors.initials: F
authors.lastname: Kunimoto
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002496:Central Venous Pressure / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015300:Ventilator Weaning / Q000379:methods*