Rousou J A, Engelman R M, Flack J E, Deaton D W, Owen S G
Department of Surgery, Baystate Medical Center, Springfield, MA 01199.
Circulation. 1994 Nov;90(5 Pt 2):II280-4.
Postoperative cardiac arrest that is not responsive to conventional resuscitation is uniformly fatal. Sixteen patients who experienced postoperative ventricular fibrillation (VF) and arrest over a 6-year period and did not respond to open chest resuscitation were placed on an emergency basis on cardiopulmonary bypass (CPB) in the cardiac surgical intensive care unit (CSICU).
Data were reviewed by retrospective analysis. Nine of the 16 patients (56.3%) survived, and they spent a mean of 9 +/- 2.8 days in the CSICU and a mean of 17 +/- 4.6 days in the hospital. They all are alive 1 month to 5 1/2 years later. The mean interval between VF/arrest and CPB in the CSICU was 50 +/- 6.7 minutes (range, 25 to 83 minutes) for survivors and 51 +/- 6.1 minutes (35 to 83 minutes) for nonsurvivors (P = .98). The duration of CPB in the CSICU was 111 +/- 16.0 minutes (range, 55 to 189 minutes) for survivors and 167 +/- 20.7 minutes (range, 80 to 232 minutes) for nonsurvivors (P = .05). There were no apparent differences between survivors and nonsurvivors in age, history of arrhythmias, use of antiarrhythmics, congestive heart failure, recent myocardial infarction, ejection fraction, preoperative intra-aortic balloon pump, urgency, or type of operation. Surgical variables and postoperative medications and electrolytes (after the primary procedure) were similar. The use of cardioplegic arrest during CPB in the CSICU was higher among survivors (3 of 9) compared with 0 of 7 for nonsurvivors (P = .21). There was no mediastinitis and only two minor soft tissue infections among survivors.
The use of CPB in the CSICU can achieve significant survival in patients who have otherwise irreversible cardiac arrest and/or VF after surgery; the incidence of infection in patients undergoing CPB in the CSICU is very low; and the use of warm cardioplegic arrest may enhance the changes of survival in this type of patient.
对传统复苏无反应的术后心脏骤停通常是致命的。16例在6年期间经历术后室颤（VF）和心脏骤停且对开胸复苏无反应的患者被紧急置于心脏外科重症监护病房（CSICU）的体外循环（CPB）下。
通过回顾性分析对数据进行审查。16例患者中有9例（56.3%）存活，他们在CSICU平均住院9±2.8天，在医院平均住院17±4.6天。1个月至5年半后他们均存活。存活者在CSICU中VF/心脏骤停与CPB之间的平均间隔为50±6.7分钟（范围25至83分钟），非存活者为51±6.1分钟（35至83分钟）（P = 0.98）。CSICU中存活者的CPB持续时间为111±16.0分钟（范围55至189分钟），非存活者为167±20.7分钟（范围80至232分钟）（P = 0.05）。存活者与非存活者在年龄、心律失常病史、抗心律失常药物使用、充血性心力衰竭、近期心肌梗死、射血分数、术前主动脉内球囊泵、紧迫性或手术类型方面无明显差异。手术变量以及术后药物和电解质（初次手术后）相似。与非存活者（7例中的0例）相比，存活者（9例中的3例）在CSICU中CPB期间使用心脏停搏的比例更高（P = 0.21）。存活者中无纵隔炎，仅有两例轻微软组织感染。
在CSICU中使用CPB可使术后发生否则将不可逆的心脏骤停和/或VF的患者获得显著的存活率；在CSICU中接受CPB的患者感染发生率非常低；使用温血心脏停搏可能会提高这类患者的存活几率。
