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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

View larger version (27K): [in a new window]   Figure 1 Treatment protocol. Standard ACLS was initiated in patients with cardiac arrest on arrival at the emergency room. When ROSC could not be achieved, emergency CPB plus IABP were immediately performed. In the cases of suspected acute coronary syndrome, emergency coronary angiography or coronary reperfusion therapy for acute coronary-artery occlusion were subsequently performed. When patient’s systolic blood pressure was increased above 90 mm Hg and Glasgow coma scale score was between 3 and 5, mild hypothermia by coil cooling was induced. ACLS = advanced cardiac life support; CPB = cardiopulmonary bypass; IABP = intraaortic balloon pumping; ROSC = return of spontaneous circulation.

View larger version (19K): [in a new window]   Figure 2 Mild hypothermia for cerebral resuscitation in patients with out-of-hospital cardiac cause of arrest. As a cooling method, coil cooling, which cools the blood circuit of continuous hemodiafiltration directly was used. As core temperature, pulmonary arterial blood temperature was monitored continuously by using a balloon flotation right-heart catheter. Induction and rewarming were conducted by two step down and slow step up methods, respectively. Hypothermia (34°C) at cooling stage continued for at least two days. Midazolam and pancuronium were used for anesthesia during this period, and nafamostat mesilate was used for control of coagulant.

View larger version (26K): [in a new window]   Figure 3 Factors relevant to good recovery in 23 patients with mild hypothermia. Point estimates and 95% confidence intervals for the odds ratios for good recovery at hospital discharge in several prospectively defined subgroups, according to cerebral performance categories. CPR = cardiopulmonary resuscitation; ELST = emergency life-saving technician; ROSC = return of spontaneous circulation.