허혈성 심질환으로 인해 병원 내에서 발생한 심정지 혹은 심정지 혹은 심인성 쇼크에 있어서의 경피적 심폐 보조장치의 치료 경험 Experiences with Emergency Percutaneous Cardiopulmonary Support in In-hospital Cardiac Arrest or Cardiogenic Shock due to the Ischemic Heart Disease원문보기
배경: 경피적 심폐 보조장치(PCPS)는 체내의 가스교환과 혈액의 관류를 간접적으로 도와줌으로써, 장기를 회복시키기 위한 다른 치료법의 사용을 용이하게 하고, 여러 다양한 임상 상황에서 출혈의 위험성을 최소화하면서 심각한 심폐부전에 빠진 환자의 생명을 구해준다. 본 저자들은 허혈성 심질환자들에서 발생한 심인성 쇼크 혹은 심정지를 PCPS로 치료한 경험을 보고하고자 한다. 대상 및 방법:1999년 5월부터 2005년 6월까지 발생한 심정지 혹은 심인성 쇼크 환자들을 대상으로 연구가 진행되었고, 환자들 중 7명에서 원심펌프인 Biopump (Medtronic inc., Minneapolis, MN), 나머지 13명에게는 자가 priming이 되는 헤파린-코팅된 EBS (Terumo, Japan)를 사용하였다. 삽관은 모든 환자에서 대퇴동맥과 대퇴 정맥을 통해서 이루어졌으며, 동맥용 케눌라는 17 Fr에서 21 Fr까지, 정맥용은 21 Fr에서 28 Fr까지 의 DLP (Medtronic inc., Minneapolis, MN) 또는 RMI (Edwards lifescienc LLC, Irvine, CA)의 비교적 긴 정맥용 케눌라를 사용하였다. 결과: 소생을 목적으로 PCPS가 시도되었던 총 20명의 환자들 중에서 심정지가 13명이었으며, 심인성 쇼크였던 환자가 7명이었다. 이들 중 11명에서 관동맥 우회술이 시행되었고, 나머지 9명의 환자에서 PCPS한 상태에서 경피적 관동맥 중재술이 시도되었다. 평균 PCPS가동 시간은 38$\pm$42시간이었으며, 총 20명의 환자들 중 PCPS 이탈이 가능하였던 11명($55\%$)의 환자 중 총 8명($40\%$)의 환자가 특별한 합병증 얼이 평균 27$\pm$17일만에 퇴원하였다. 퇴원한 환자는 현재 모두 생존하여 치장 31개월째 외래 추적관찰 중이다. 결론: PCPS를 시행함으로써 혈역학적 회복을 가져옴으로써 다른 방법으로는 살리기 힘들었던 심정지 또는 심인성 쇼크로부터 환자를 구할 수 있고, 일단 회복된 환자들은 장기 생존율을 보인다.
배경: 경피적 심폐 보조장치(PCPS)는 체내의 가스교환과 혈액의 관류를 간접적으로 도와줌으로써, 장기를 회복시키기 위한 다른 치료법의 사용을 용이하게 하고, 여러 다양한 임상 상황에서 출혈의 위험성을 최소화하면서 심각한 심폐부전에 빠진 환자의 생명을 구해준다. 본 저자들은 허혈성 심질환자들에서 발생한 심인성 쇼크 혹은 심정지를 PCPS로 치료한 경험을 보고하고자 한다. 대상 및 방법:1999년 5월부터 2005년 6월까지 발생한 심정지 혹은 심인성 쇼크 환자들을 대상으로 연구가 진행되었고, 환자들 중 7명에서 원심펌프인 Biopump (Medtronic inc., Minneapolis, MN), 나머지 13명에게는 자가 priming이 되는 헤파린-코팅된 EBS (Terumo, Japan)를 사용하였다. 삽관은 모든 환자에서 대퇴동맥과 대퇴 정맥을 통해서 이루어졌으며, 동맥용 케눌라는 17 Fr에서 21 Fr까지, 정맥용은 21 Fr에서 28 Fr까지 의 DLP (Medtronic inc., Minneapolis, MN) 또는 RMI (Edwards lifescienc LLC, Irvine, CA)의 비교적 긴 정맥용 케눌라를 사용하였다. 결과: 소생을 목적으로 PCPS가 시도되었던 총 20명의 환자들 중에서 심정지가 13명이었으며, 심인성 쇼크였던 환자가 7명이었다. 이들 중 11명에서 관동맥 우회술이 시행되었고, 나머지 9명의 환자에서 PCPS한 상태에서 경피적 관동맥 중재술이 시도되었다. 평균 PCPS가동 시간은 38$\pm$42시간이었으며, 총 20명의 환자들 중 PCPS 이탈이 가능하였던 11명($55\%$)의 환자 중 총 8명($40\%$)의 환자가 특별한 합병증 얼이 평균 27$\pm$17일만에 퇴원하였다. 퇴원한 환자는 현재 모두 생존하여 치장 31개월째 외래 추적관찰 중이다. 결론: PCPS를 시행함으로써 혈역학적 회복을 가져옴으로써 다른 방법으로는 살리기 힘들었던 심정지 또는 심인성 쇼크로부터 환자를 구할 수 있고, 일단 회복된 환자들은 장기 생존율을 보인다.
Background: Percutaneous cardiopulmonary support (PCPS) provides passive support of gas exchange and perfusion, allowing the use of other methods of care for organ recovery, and saves lives of patients with severe cardiopulmonary failure in a wide variety of clinical settings with a minimal risk of ...
Background: Percutaneous cardiopulmonary support (PCPS) provides passive support of gas exchange and perfusion, allowing the use of other methods of care for organ recovery, and saves lives of patients with severe cardiopulmonary failure in a wide variety of clinical settings with a minimal risk of bleeding and need for chest re~ exploration. We summarized a single center's experiences with PCPS in patients with cardiogenic shock or cardiac arrest due to the ischemic heart disease. Material and Method: Among the 20 consecutive patients with cardiogenic shock or cardiac arrest from May 1999 to June 2005, Biopump (Medtronic, Inc, Minneapolis, MN) was used in 7 patients and the self-priming, heparin-coated circuit of EBS (Terumo, Japan) was applied to remaining 13 patients. Most of cannulations were performed percutaneously via femoral arteries and veins. The long venous cannulas of DLP (Medtronic inc. Minneapolis, MN) or the RMI (Edwards's lifescience LLC, Irvine, CA) were used with the arterial cannulae from 17 Fr to 21 Fr and the venous cannula from 21 Fr to 28 Fr. Result: The 20 consecutive patients who were severely compromised and received PCPS for the purpose of resuscitation were comprised of 13 cardiac arrests and 7 cardiogenic shocks in which by-pass surgery was performed in 11 patients and 9 ongoing PCls under the cardiopulmonary support. The mean support time on the PCPS was 38$\pm$42 hours. Of the 20 patients implanted with PCPS, 11 patients ($55\%$) have had the PCPS removed successfully; overall, 8 of these patients ($40\%$) were discharged from the hospital in an average surviving time for 27$\pm$17 days after removing the PCPS and survived well with 31$\pm$30 months of follow-up after the procedure. Conclusion: The use of PCPS appears to provide the hemodynamic restoration, allowing the survival of patients in cardiac arrest or cardiogenic shock who would otherwise not survive, and patients receiving PCPS had a relatively long-term survival.
Background: Percutaneous cardiopulmonary support (PCPS) provides passive support of gas exchange and perfusion, allowing the use of other methods of care for organ recovery, and saves lives of patients with severe cardiopulmonary failure in a wide variety of clinical settings with a minimal risk of bleeding and need for chest re~ exploration. We summarized a single center's experiences with PCPS in patients with cardiogenic shock or cardiac arrest due to the ischemic heart disease. Material and Method: Among the 20 consecutive patients with cardiogenic shock or cardiac arrest from May 1999 to June 2005, Biopump (Medtronic, Inc, Minneapolis, MN) was used in 7 patients and the self-priming, heparin-coated circuit of EBS (Terumo, Japan) was applied to remaining 13 patients. Most of cannulations were performed percutaneously via femoral arteries and veins. The long venous cannulas of DLP (Medtronic inc. Minneapolis, MN) or the RMI (Edwards's lifescience LLC, Irvine, CA) were used with the arterial cannulae from 17 Fr to 21 Fr and the venous cannula from 21 Fr to 28 Fr. Result: The 20 consecutive patients who were severely compromised and received PCPS for the purpose of resuscitation were comprised of 13 cardiac arrests and 7 cardiogenic shocks in which by-pass surgery was performed in 11 patients and 9 ongoing PCls under the cardiopulmonary support. The mean support time on the PCPS was 38$\pm$42 hours. Of the 20 patients implanted with PCPS, 11 patients ($55\%$) have had the PCPS removed successfully; overall, 8 of these patients ($40\%$) were discharged from the hospital in an average surviving time for 27$\pm$17 days after removing the PCPS and survived well with 31$\pm$30 months of follow-up after the procedure. Conclusion: The use of PCPS appears to provide the hemodynamic restoration, allowing the survival of patients in cardiac arrest or cardiogenic shock who would otherwise not survive, and patients receiving PCPS had a relatively long-term survival.
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제안 방법
All 14 patients required the PCPS used as an emergency procedure to resuscitate and stabilize patients with circulatory collapse in order to attempt the urgent coronary revascularization. In 9 of the 14 cases, the PCI was carried out in the catheterization laboratory on PCPS with the complete revascularization in 6 patients (67%).
대상 데이터
The large variations at outcomes may be caused by various reasons such as, the variable delay until the onset of PCPS and the varying degree of experience with the techniques; however, the most important factor responsible for the marked differences in survival is the patient selection[8]. In our series 14 of 20 patients, treated by PCPS for cardiac anest or cardiogenic shock, underwent emergency coronary revascularizations, CABG in 5 and PCI in 9. Our rate of weaning from PCPS (55%, 11/20) and survival rate (57%, 8/14) were somewhat better than the rates previously reported.
Biopump® (Medtronic) was used in 7 patients and the self-priming, heparin-coated circuit of EBS® (Terumo) was applied to remaining 13 patients. The percutaneous approach was applied in 15 patients, and the open surgical technique was done in remaining 5 patients. The mean time from the onset of cardiogenic shock or cardiac anest to the initiation of PCPS was 28±35 min (range 10—170 min).
데이터처리
All values are expressed as the mean±SD. Comparison between quantitative data was performed by the student's t-test. A p<0.
성능/효과
Eleven of the 20 patients (55%) in this series could be weaned from PCPS or cardiopulmonary bypass initially, however, only 8 patients (40%) survived and they were discharged from the hospital 27± 17 days after medical treatment with survival rates of 36% for CABG, 44% for PCI. All 8 patients were long-term survivors, 3 of 8 patients with cardiogenic shock vs. remaining 5 patients with cardiac arrest and maintained the good quality of life at a 6 month follow-up. In the nonrecovered who were unable to wean from the PCPS, however, postoperative cardiac contraction did not improve and finally the patients died on PCPS.
2 L/min/m2, and the most patients showed the clinical and hemodynamic improvement at those flow rates. Eleven of the 20 patients (55%) in this series could be weaned from PCPS or cardiopulmonary bypass initially, however, only 8 patients (40%) survived and they were discharged from the hospital 27± 17 days after medical treatment with survival rates of 36% for CABG, 44% for PCI. All 8 patients were long-term survivors, 3 of 8 patients with cardiogenic shock vs.
참고문헌 (14)
Reedy JE, Swartz MT, Raithel SC, Szukalski EA, Pennington DG. Mechanical cardiopulmonary support for refractory cardiogenic shock. Heart Lung 1990;19:514-23
Shawl FA, Domanski MJ, Punja A, Hemandez T. Emergency percutaneous cardiopulmonary bypass support in cardiopulmonary shock from acute myocardial infarction. Am J Cardiol 1989;64:967-70
Pan M, Suarez de Lezo J, Medina A, et al. In-laboratory removal of femoral sheath following protamin administration in patients having intracoronary stents implantation. Am J Cardiol 1997;80:1336-8
Reichman RT, Joyo CI, Dembitsky WP, et al. Improved patient survival after cardiac arrest using a cardiopulmonary support system. Ann Thorac Surg 1990;49:101-5
Matsuwaka R, Sakakibara T, Shintani H, et al. Emergency cardiopulmonary bypass support in patients with severe cardiogenic shock after acute myocardial infarction. Heart Vessels 1996;11:27-9
Suarez de Lezo J, Pan M, Medina A, et al. Percutaneous cardiopulmonary support in critical patients needing coronary interventions with stents. Cathet Cardiovasc Intervent 2002;57:467-75
Scholz KH, Figulla HR, Schroder T, et al. Pulmonary and left ventricular decompression by artificial pulmonary valve incompetence during percutaneous cardiopulmonary bypass support in cardiac arrest. Circulation 1995;91:2664-8
Murashita T, Eya K, Miyatake T, et al. Outcome of the perioperative use of percutaneous cardiopulmonary support for adult cardiac surgery: factors affecting hospital mortality. Artif Organs 2004;28:189-95
Orime Y, Shino M, Hata H, et al. Clinical experiences of percutaneous cardiopulmonary support: its effectiveness and limit. Artif Organs 1998;22:498-501
Yamashita C, Ataka T, Azami T, et al. Usefulness of post operative percutaneous cardiopulmonary support using a centrifugal pump: retrospective analysis of complications. Artif Organs 1999;23:360-5
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