Emergency department cardiopulmonary bypass in the treatment of human cardiac arrest.

OBJECTIVE

To study the use of emergency department (ED) femoro-femoral cardiopulmonary bypass (CPB) in the resuscitation of medical cardiac arrest patients.

DESIGN

Prospective, uncontrolled trial.

SETTING

Urban academic ED staffed with board-certified emergency physicians (EPs).

PARTICIPANTS

Ten patients with medical cardiac arrest unresponsive to standard therapy.

INTERVENTIONS

Femoro-femoral CPB instituted by EPs.

RESULTS

The time of cardiac arrest prior to CPB (mean+/-SD) was 32.0+/-13.6 min. The cardiac output while on CPB was 4.09+/-1.03 L/min with an average of 229+/-111 min on bypass. All 10 patients had resumption of spontaneous cardiac activity while on CPB. Seven of these were weaned from CPB with intrinsic spontaneous circulation. Of these, six patients were transferred from the ED to the operating room for cannula removal and vessel repair while the other patient died in the ED soon after discontinuing CPB. Mean survival was 47.8+/-44.7 h in the six patients leaving the ED. Although these patients had successful hemodynamic resuscitation, there were no long-term survivors.

CONCLUSION

CPB instituted by EPs is feasible and effective for the hemodynamic resuscitation of cardiac arrest patients unresponsive to advanced cardiac life support therapy. Future efforts need to focus on improving long-term outcome.