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CARDIAC ARREST

Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital

Ken Nagao, MD^*, Nariyuki Hayashi, MD^*, Katsuo Kanmatsuse, MD, FACC, Ken Arima, MD, Jyoji Ohtsuki, MD^*, Kimio Kikushima, MD and Ikuyoshi Watanabe, MD^*

^* Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan
Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan

Manuscript received June 25, 1999; revised manuscript received March 13, 2000, accepted April 14, 2000.

Reprint requests and correspondence: Dr. Ken Nagao, Surugadai Nihon University Hospital 1-8-13, Kanda Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan

OBJECTIVES

The purpose of this study was to evaluate the efficacy of an alternative cardiopulmonary cerebral resuscitation (CPCR) using emergency cardiopulmonary bypass (CPB), coronary reperfusion therapy and mild hypothermia.

BACKGROUND

Good recovery of patients with out-of-hospital cardiac arrest is still inadequate. An alternative therapeutic method for patients who do not respond to conventional CPCR is required.

METHODS

A prospective preliminary study was performed in 50 patients with out-of-hospital cardiac arrest meeting the inclusion criteria. Patients were treated with standard CPCR and, if there was no response, by emergency CPB plus intra-aortic balloon pumping. Immediate coronary angiography for coronary reperfusion therapy was performed in patients with suspected acute coronary syndrome. Subsequently, in patients with systolic blood pressure above 90 mm Hg and Glasgow coma scale score of 3 to 5, mild hypothermia (34°C for at least two days) was induced by coil cooling. Neurologic outcome was assessed by cerebral performance categories at hospital discharge.

RESULTS

Thirty-six of the 50 patients were treated with emergency CPB, and 30 of 39 patients who underwent angiography suffered acute coronary artery occlusion. Return of spontaneous circulation and successful coronary reperfusion were achieved in 92% and 87%, respectively. Mild hypothermia could be induced in 23 patients, and 12 (52%) of them showed good recovery. Factors related to a good recovery were cardiac index in hypothermia and the presence of serious complications with hypothermia or CPB.

CONCLUSIONS

The alternative CPCR demonstrated an improvement in the incidence of good recovery. Based upon these findings, randomized studies of this hypothermia are needed.

Abbreviations and Acronyms   ACLS = advanced cardiac life support   CPB = cardiopulmonary bypass   CPCR = cardiopulmonary cerebral resuscitation   CPR = cardiopulmonary resuscitation   ELST = emergency life-saving technician   IABP = intra-aortic balloon pumping   PTCA = percutaneous transluminal coronary angioplasty   ROSC = return of spontaneous circulation   TIMI = thrombolysis in myocardial infarction   VF = ventricular fibrillation

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