Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy.
Artif Organs. 2009 Oct;33(10):788-97. doi: 10.1111/j.1525-1594.2009.00811.x.
Acute cardiogenic shock or cardiac arrest (CS/CA) before cardiopulmonary bypass (CPB) installation are life-threatening events in acute coronary syndromes. We evaluated whether continuous retrograde warm-blood perfusion(CRWBP) before aortic cross-clamping (ACC),with immediate CPB installation may improve hospital results in these dreadful events. Hospital outcome of 18 coronary artery bypass grafting (CABG) (Group A) with CS/CA before CPB, with immediate CPB installation and CRWBP,has been compared with 24 CABG (Group B) with CS/CA undergoing only immediate CPB installation. No differences have been detected in the mean time to establish CPB(P = 0.655). Electrocardiography normalized in a significantly higher number of CRWBP (P = 0.0001). Group B showed longer CPB (116.2 +/- 21.2 min vs. 157.8 +/- 32.4;P = 0.0001) and postoperative intra-aortic balloon pumping time course (36.2 +/- 5.9 h vs. 77.8 +/-13.2; P = 0.0001).CRWBP reduced postoperative acute myocardial infarction (P = 0.004) and damage (P = 0.033), death (P = 0.026),and need for high inotropic support (0% vs. 37.5%; P =0.003). Troponin I was significantly lower in Group A(P = 0.013 from coronary sinus; P </= 0.0001 at 12, 24, and 48 h postoperatively; P = 0.008 at 72 h), never reaching values suggestive of acute myocardial infarction. Group A had also lower lactate release from aortic declamping to 48 h postoperatively (P </= 0.0001).CRWBP improved post operative left ventricular ejection fraction (EF) (P = 0.017)and wall motion score index (P = 0.041), whereas Group B showed a significant worsening of EF (P = 0.0001) and wall motion score index (P = 0.002). Patients in Group A had shorter intubation time (P = 0.0001), intensive therapy unit(ITU) stay (P = 0.001), and hospital stay (P = 0.0001).CRWBP reverses myocardial damage in patients with CS/CA during acute coronary syndromes, adding a straightforward benefit to hospital survival.
在进行体外循环 (CPB) 安装之前，急性心源性休克或心脏骤停 (CS/CA) 是急性冠状动脉综合征中的危及生命的事件。我们评估了在主动脉夹闭 (ACC) 前进行连续逆行温血灌注 (CRWBP)，并立即安装 CPB 是否可以改善这些可怕事件中的医院结果。将 18 例冠状动脉旁路移植术 (CABG) (A 组) 与 CS/CA 患者在 CPB 前、立即进行 CPB 安装和 CRWBP 治疗的住院结果与仅立即进行 CPB 安装的 24 例 CABG (B 组) 进行比较。建立 CPB 的平均时间无差异 (P = 0.655)。CRWBP 组心电图正常的比例明显更高 (P = 0.0001)。B 组 CPB 时间较长 (116.2 +/- 21.2 分钟比 157.8 +/- 32.4 分钟；P = 0.0001) 和术后主动脉内球囊反搏时间过程较长 (36.2 +/- 5.9 小时比 77.8 +/- 13.2 小时；P = 0.0001)。CRWBP 降低了术后急性心肌梗死 (P = 0.004) 和损伤 (P = 0.033)、死亡 (P = 0.026) 和需要高正性肌力支持的发生率 (0%比 37.5%；P = 0.003)。A 组肌钙蛋白 I 明显较低 (P = 0.013 来自冠状窦；P </= 0.0001 在术后 12、24 和 48 小时；P = 0.008 在 72 小时)，从未达到急性心肌梗死的提示值。A 组从主动脉钳夹到术后 48 小时的乳酸释放也较低 (P </= 0.0001)。CRWBP 改善了术后左心室射血分数 (EF) (P = 0.017) 和壁运动评分指数 (P = 0.041)，而 B 组 EF (P = 0.0001) 和壁运动评分指数 (P = 0.002) 明显恶化。A 组患者的插管时间 (P = 0.0001)、重症监护病房 (ITU) 停留时间 (P = 0.001) 和住院时间 (P = 0.0001) 均较短。CRWBP 在急性冠状动脉综合征中逆转 CS/CA 患者的心肌损伤，为医院生存带来直接益处。
