Document Detail


Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest.
MedLine Citation:
PMID:  2403478     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
After cardiac arrest (no flow) of more than approximately 5 minutes' duration, standard external cardiopulmonary resuscitation (CPR) basic, advanced, and prolonged life support (BLS, ALS, PLS) do not reliably produce cerebral and coronary perfusion pressures to maintain viability and achieve stable spontaneous normotension; nor do they provide prolonged control over pressure, flow, composition, and temperature of blood. Since these capabilities are often needed to achieve conscious survival, emergency closed-chest cardiopulmonary bypass (CPB) by veno-arterial pumping via oxygenator is presented in this review as a potential addition to ALS-PLS for selected cases. In six dog studies by the Pittsburgh group (n = 221; 1982 through 1988), all 179 dogs that received CPB after prolonged cardiac arrest (no flow) or after CPR (low flow) states had restoration of stable spontaneous circulation. The use of CPB enhanced survival and neurological recovery over those achieved with CPR-ALS attempts only. With CPB and standard intensive care, it was possible to reverse normothermic ventricular fibrillation (VF) cardiac arrest (no flow) of up to 15 minutes and to achieve survival without neurologic deficit; VF of 20 minutes to achieve survival but with neurologic deficit; and VF of 30 minutes to achieve transient restoration of spontaneous circulation followed by secondary cardiac death. CPB could restore stable spontaneous circulation after ice water submersion of up to 90 minutes. Other groups' laboratory and clinical results agree with these findings in general. Clinical feasibility trials are needed to work out logistic problems and to meet clinical challenges. Future possibilities for emergency CPB require further research and development.
Authors:
P Safar; N S Abramson; M Angelos; R Cantadore; Y Leonov; R Levine; E Pretto; H Reich; F Sterz; S W Stezoski
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  8     ISSN:  0735-6757     ISO Abbreviation:  Am J Emerg Med     Publication Date:  1990 Jan 
Date Detail:
Created Date:  1990-02-07     Completed Date:  1990-02-07     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  55-67     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, PA 15260.
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MeSH Terms
Descriptor/Qualifier:
Animals
Cardiopulmonary Bypass*
Dogs
Emergencies
Heart Arrest / therapy*
Life Support Care
Resuscitation*
Time Factors
Grant Support
ID/Acronym/Agency:
NS15295/NS/NINDS NIH HHS; NS24446/NS/NINDS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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