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ȣ - 530381 393 |
Percutaneous cardiopulmonary support in fulminant shock |
성균관대학교 삼성서울병원 순환기 내과 |
최준혁, 송영빈,한주용,최진호,최승혁,권현철,이상훈 |
Background:Emergent percutaneous cardiopulmonary support (PCPS) provides hemodynamic stability for the treatment of patients suffering from fulminant shock who might otherwise die. In this study, we summarize a single center’s experience with performing PCPS in patients who suffered from fulminant shock. Methods:We studied 204 consecutive patients with fulminant shock who received PCPS from January 1995 to November 2008. Cannulation was performed via the femoral artery and vein using an arterial (17 to 21 French) and venous cannula (21 to 28 French) percutaneously. Results:Indications for PCPS were cardiogenic shock (n=128), postoperative shock (n=60), and other fulminant shock (n=16). Cardiogenic shock was divided into ischemic heart disease (IHD) (n=76), fulminant myocarditis (n=16), and other cardiogenic shock (n=36). The median (range) age was 61(47-70) years and 138(68%) patients were male. 128(63%) patients were performed with PCPS due to cardiopulmonary resuscitation (CPR). Overall, 76 patients (37%) survived and 105 patients (52%) were weaned off the PCPS. In fulminant myocarditis, 13 patients (81%) survived and 20 patients (56%) were weaned off the PCPS. In ischemic heart disease, 34 patients (45%) survived and 46 patients (61%) were weaned off the PCPS. Comparison of baseline demographic and periprocedural factors between survivors and non-survivors were shown in Table. Even though the presence of CPR didn't influence the survival rate, when the CPR duration was analyzed, the survivors were likely to have a much shorter CPR duration (25 (15-50) min in survivors vs. 42 (24-60) min in nonsurvivor, p=0.012). Conclusion:This analysis demonstrated the effectiveness of using PCPS for the treatment of critically unstable patients. In particular, PCPS provides an acceptable survival rate and outcome in patients with ischemic heart disease and fulminant myocarditis.
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Table A comparison of the periprocedural factors between patients who died in the hospital (nonsurvivor) and those discharged from hospital (non survivor).
Factors |
Survivor |
Nonsurvivors |
p |
N |
76 |
128 |
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Male gender,(%) |
51(67) |
87(68) |
1.000 |
Age > 70years |
15(20) |
41(32) |
0.057 |
Fulminant myocarditis as an indication, (%) |
13(17) |
3(2) |
<0.001 |
Use of IABP, (%) |
40(53) |
44(34) |
0.010 |
ARF, (%) |
22(29) |
66(52) |
0.002 |
CPR, (%) |
43(57) |
86(67) |
0.160 |
Time from shock to PCPS(hours) |
1.9(0.8-6.3) |
1.9(1.0-6.0) |
0.804 |
PCPS duration(hours) |
56(26.3-95.8) |
52.5(9.0-143.8) |
0.511 |
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