Emergency cardio-pulmonary bypass in cardiac arrest: seventeen years of experience.
OBJECTIVE
Emergency cardiopulmonary bypass (E-CPB) is an advanced and rarely used procedure for patients in cardiac arrest that do not regain restoration of spontaneous circulation with standard resuscitation methods. The feasibility, safety and outcome of the intervention with E-CPB in cardiac arrest situations at our department have been evaluated.


METHODS
Clinical presentation, time intervals, diagnosis and outcome of all patients who received E-CPB at an emergency department of a tertiary care university hospital were evaluated. Patient charts were reviewed regarding cardiac arrest variables and treatment data of all patients from 1993 to 2010.


RESULTS
E-CPB was performed in 55 patients. Of all patients, 33 (60%) were male and the median age was 32 years (IQR 24-44). In all cases cardiac arrest was witnessed. The first recorded ECG rhythm showed pulseless electric activity in 23 (42%), ventricular fibrillation in 21 (38%) and asystole in 11 (20%) patients. Cardiac arrest occurred out-of-hospital in 33 (60%) patients. The median duration of CPR before performing E-CPB was 86 min (IQR 69-121). The median 'cannulation'-time was 33 min (IQR 21-45) and the duration on bypass was 311 min (IQR 161-953). Cardiac causes of arrest were found in 19 (35%) patients. Eight patients (15%) survived to 6 months with good neurological outcome.


CONCLUSIONS
E-CPB for cardiac arrest is feasible and safe. In this seemingly desperate patient population after prolonged cardiac arrest, we observed a high survival rate of 15%. E-CPB is a meaningful treatment option, which should be considered more often and earlier.
Department of Emergency Medicine, Medical University Vienna, Austria.
Christian
C
Wallmüller
Fritz
F
Sterz
Christoph
C
Testori
Andreas
A
Schober
Peter
P
Stratil
David
D
Hörburger
Mathias
M
Stöckl
Christoph
C
Weiser
Danica
D
Kricanac
Daniel
D
Zimpfer
Zeno
Z
Deckert
Michael
M
Holzer
D000328:Adult; D001317:Austria / Q000453:epidemiology; D002315:Cardiopulmonary Bypass / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult