Guarneri E M, Califano J R, Schatz R A, Morris N B, Teirstein P S
Division of Cardiovascular Diseases, Scripps Clinic and Research Foundation, La Jolla, California 92037, USA.
Catheter Cardiovasc Interv. 1999 Jan;46(1):32-5. doi: 10.1002/(SICI)1522-726X(199901)46:1<32::AID-CCD8>3.0.CO;2-8.
At our institution, elective coronary interventions are performed without formal surgical backup. Instead, a policy of "standby cardiopulmonary support" (CPS), and "next-available operating room" is used. Standby CPS requires a perfusionist dedicated to the catheterization laboratory with immediate access to CPS apparatus. Between January 1989 and June 1994 we performed 2,850 elective coronary interventions. Eleven patients (0.4%) required emergency CPS. None of these patients fell into a high-risk category for PTCA (i.e., sole circulation, ejection fraction <20%, unprotected left main). Eight of these (73%) had completion of their coronary intervention while on CPS in the catheterization laboratory. Three patients were sustained on CPS until an operating room became available. All patients required blood transfusions and sustained non-Q-wave myocardial infarctions. Two late in-hospital deaths occurred. Nine patients (82%) were successfully discharged. Standby CPS provides hemodynamic support for patients who sustain a potentially catastrophic event during coronary intervention. Our data suggest that this modality should not be limited to high-risk patients.
在我们机构，择期冠状动脉介入治疗在没有正式外科支持的情况下进行。相反，采用了“备用心肺支持”（CPS）和“下一个可用手术室”的策略。备用CPS需要一名灌注师专门负责导管室，并能立即使用CPS设备。1989年1月至1994年6月期间，我们进行了2850例择期冠状动脉介入治疗。11例患者（0.4%）需要紧急CPS。这些患者中没有一例属于PTCA的高危类别（即单循环、射血分数<20%、无保护左主干）。其中8例（73%）在导管室接受CPS时完成了冠状动脉介入治疗。3例患者在CPS支持下直至有可用的手术室。所有患者均需要输血并发生持续性非Q波心肌梗死。发生了2例晚期院内死亡。9例患者（82%）成功出院。备用CPS为冠状动脉介入治疗期间发生潜在灾难性事件的患者提供血流动力学支持。我们的数据表明，这种方式不应仅限于高危患者。
