Shawl F A, Domanski M J, Wish M H, Davis M, Punja S, Hernandez T J
Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland 20912.
Cathet Cardiovasc Diagn. 1990 Jan;19(1):8-12. doi: 10.1002/ccd.1810190104.
Cardiac arrest in the catheterization laboratory is fatal if unresponsive to advanced cardiac life support (ACLS). Seven patients not responding to ACLS following cardiac arrest in the catheterization laboratory underwent percutaneously instituted cardiopulmonary bypass support. Cardiac arrest occurred following abrupt closure postcoronary angioplasty in three patients, during cardiogenic shock in three patients, and during diagnostic angiography in one patient. Cardiopulmonary bypass was instituted 10-45 min (mean, 21 min) following the onset of cardiac arrest. Flows on bypass ranged from 4.0 to 5.2 liter/min. Mean blood pressure ranged from 70 to 110 mm Hg on bypass. Six of the seven patients regained consciousness after the institution of bypass. Acid-base balance was normalized in all patients. Coronary bypass surgery was subsequently performed in three patients and coronary angioplasty in two. Four patients survived. One patient died following coronary bypass surgery. Two patients, who were not suitable candidates for revascularization, expired. Total bypass time was 1.5-8.5 hr (mean, 2.7 hr). At a mean follow-up of 6 months, all four survivors are alive and asymptomatic or NYHA class 1. We conclude that cardiopulmonary bypass support 1) can stabilize patients following cardiac arrest in the catheterization laboratory, 2) can facilitate emergency coronary angioplasty or transfer to the operating room for coronary bypass surgery, and (3) can improve survival in patients unresponsive to ACLS when instituted early following cardiac arrest in the catheterization laboratory.
在导管室发生的心搏骤停若对高级心脏生命支持（ACLS）无反应则是致命的。7例在导管室心搏骤停后对ACLS无反应的患者接受了经皮建立的体外循环支持。3例患者在冠状动脉血管成形术后突然闭塞后发生心搏骤停，3例在心源性休克期间发生，1例在诊断性血管造影期间发生。心搏骤停发生后10 - 45分钟（平均21分钟）开始建立体外循环。体外循环流量为4.0至5.2升/分钟。体外循环期间平均血压为70至110毫米汞柱。7例患者中有6例在建立体外循环后恢复意识。所有患者的酸碱平衡均恢复正常。随后3例患者进行了冠状动脉搭桥手术，2例进行了冠状动脉血管成形术。4例患者存活。1例患者在冠状动脉搭桥手术后死亡。2例不适合进行血运重建的患者死亡。体外循环总时间为1.5 - 8.5小时（平均2.7小时）。平均随访6个月时，所有4名幸存者均存活且无症状或纽约心脏协会（NYHA）心功能1级。我们得出结论，体外循环支持1）可使导管室心搏骤停后的患者稳定下来，2）可便于进行紧急冠状动脉血管成形术或转至手术室进行冠状动脉搭桥手术，并且（3）在导管室心搏骤停后早期实施时，可提高对ACLS无反应患者的生存率。
