Cho Yang Hyun, Kim Wook Sung, Sung Kiick, Jeong Dong Seop, Lee Young Tak, Park Pyo Won, Kim Duk-Kyung
From the *Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and †Department of Internal Medicine, Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
ASAIO J. 2014 May-Jun;60(3):280-3. doi: 10.1097/MAT.0000000000000063.
Cardiac arrest caused by acute pulmonary embolism is associated with high patient mortality. We reviewed patients who had cardiac arrest caused by acute pulmonary embolism. Between January 2001 and September 2013, we identified 20 patients at our institution with a confirmative diagnosis of acute pulmonary thromboembolism and cardiac arrest. Percutaneous cardiopulmonary support (PCPS) and surgical embolectomy are the standard course of care for patients with shock or cardiac arrest caused by pulmonary thromboembolism at our institution. Patients were divided into two groups (PCPS group and non-PCPS group). Percutaneous cardiopulmonary support was used in 60% of patients. Surgical embolectomy was performed for 85% of patients. Overall in-hospital and surgical mortalities were 35% and 29%, respectively. On the basis of the multivariate analysis, both cardiopulmonary resuscitation more than 15 minutes and absence of PCPS were significant risk factors affecting survival (p = 0.001 and 0.049, respectively). When the duration of cardiac arrest is short, surgical embolectomy is a viable option after cardiac arrest caused by pulmonary thromboembolism. Percutaneous cardiopulmonary support may be a useful tool for both stabilizing the patient and providing a bridge when deciding on further management options.
急性肺栓塞所致心脏骤停与患者高死亡率相关。我们回顾了因急性肺栓塞导致心脏骤停的患者。在2001年1月至2013年9月期间，我们在本机构确定了20例确诊为急性肺血栓栓塞症并发生心脏骤停的患者。经皮心肺支持（PCPS）和手术取栓是我们机构对肺血栓栓塞所致休克或心脏骤停患者的标准治疗方案。患者被分为两组（PCPS组和非PCPS组）。60%的患者使用了经皮心肺支持。85%的患者接受了手术取栓。总体住院死亡率和手术死亡率分别为35%和29%。基于多变量分析，心肺复苏超过15分钟和未使用PCPS均是影响生存的显著危险因素（p值分别为0.001和0.049）。当心脏骤停持续时间较短时，手术取栓是肺血栓栓塞导致心脏骤停后的可行选择。经皮心肺支持可能是稳定患者病情以及在决定进一步治疗方案时提供过渡的有用工具。
