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Shin, Lee, Na, Jang, and Oh: Percutaneous Cardiopulmonary Support Experience of a National University Hospital in Busan
Original Article

Kosin Medical Journal 2015;30(1):23-28.

Published online: 20 January 2015

DOI: https://doi.org/10.7180/kmj.2015.30.1.23

Percutaneous Cardiopulmonary Support Experience of a National University Hospital in Busan

Dong Hun Shin1, Min Jin Lee1, Hae Jung Na1, Sun Mi Jang1, Jun-Hyok Oh2,

1Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea

2Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea

Corresponding Author：Jun-Hyok Oh, Department Cardiclogy, Medical Research Institute, Pusan National University Hospital, 305, Gudeok-ro Seo-gu, Busan, Korea TEL: +82-51-240-7221 FAX: +82-51-247-5875 E-mail: jhoh724@hanmail.net

Received 17 April 201414 July 2014       Accepted 5 August 2014

Copyright © 2015 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Cardiopulmonary support has been used to treat the patients with refractory cardiogenic shock since 1950s. In advent of portable system its use has been widened considerably. In this retrospective study, we report our single center experience concerning possible indications, complications and outcomes of percutanous cardiopulmonary support (PCPS)

Methods

From January 2013 to March 2014, we searched the patients who were supported by PCPS system by reviewing the medical records in cardiology department at our Hospital. Infectious organism was limited to what was identified within 2 weeks after weaning of PCPS.

Results

A total of 9 patients were supported by PCPS with CAPIOX CX® system (Terumo inc., Tokyo, Japan) initially for ST-segment elevation myocardial infarction/non ST-segment elevation myocardial infarction in 4 patients, myocarditis in 3 patients, valvular heart disease in 1 patient, and acute respiratory distress syndrome in 1 patient. The mean duration of PCPS support was 79.1±76.6 hours and 5 of them were recovered and discharged alive. All the patients needed transfusions of various forms of blood products. And there was one major stroke and one hyperbilirubinemia in related to PCPS treatment.

Conclusions

PCPS treatment was a valuable means to treat the patients with cardiovascular collapse, but not without costs. Efforts to reduce its associated complications should be made to improve outcomes.

Keywords: Percutanous cardiopulmonary support

References

1. Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954; 37:171–85.
2. Jaski BE, Ortiz B, Alla KR, Smith SC, Glaser D, Walsh C, et al. A 20-year experience with urgent percutaneous cardiopulmonary bypass for salvage of potential survivors of refractory cardiovascular collapse. J Thorac Cardiovasc Surg. 2010; 139:753–7. e751–2.
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3. Aoyama N, Izumi T, Hiramori K, Isobe M, Kawana M, Hiroe M, et al. National survey of fulminant myocarditis in japan: Therapeutic guidelines and longterm prognosis of using percutaneous cardiopulmonary support for fulminant myocarditis (special report from a scientific committee). Circ J. 2002; 66:133–44.
4. Rhee Il, Gwon Hyeon-Cheol, Choi Jinho, Sung Kiick, Lee Young Tak, Kwon Sung-Uk, et al. Percutaneous Cardiopulmonary Support for Emergency In-Hospital Cardiac Arrest or Cardiogenic Shock. Korean Circulation J. 2006; 36:11–6.
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5. Cho Sung Soo, Oh Chang-Myung, Jang Ji-Yong, Yu Hee Tae, Bang Woo-Dae, Kim Jung-Sun, et al. Percutaneous Cardiopulmonary Support-Supported Percutaneous Coronary Intervention: A Single Center Experience. Korean Circ J. 2011; 41:299–303.
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6. Orime Y, Shiono M, Hata H, Yagi S, Tsukamoto S, Okumura H, et al. Clinical Experiences of Percutaneous Cardiopulmonary Support: Its Effectiveness and Limit. Artificial Organs. 1998; 22:498–501.
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Table 1.
Patient characteristics
Patient No. Sex/Age (years) Diagnosis Risk factors Prior Stroke CPR Rhythm S BP before PC (mmHg) CPS Clinical outcome
1 M/68 STEMI HTN, Sm – – NSR 40 Death (cardiogenic)
2 M/55 Severe MR   – + AFL 80 Recovery
3 M/53 Myocarditis HTN, Sm – + IVR 70 Recovery
4 M/58 Myocarditis HTN – – CAVB 70 Recovery
5 M/81 STEMI HTN – + CAVB 0 Death (cardiogenic)
6 F/67 ARDS, severe MS 　 + – Afib 92 Death (sepsis)
7 F/72 STEMI HTN, DM + + NSR 60 Death(cardiogenic)
8 M/23 Viral myocarditis   – – NSR 70 Recovery
9 M/74 NSTEMI HTN, DM, Sm – + Afib 70 Recovery

Afib = atrial fibrillation; AFL = atrial flutter; ARDS = acute respiratory distress syndrome; CAVB = complete AV block; CPR = cardiopulmonary resuscitation; DM = Diabetes mellitus; HTN = hypertension; IVR = idiopathic ventricular rhythm; MR = mitral valve regurgitation; MS = mitral valve stenosis; SBP = systolic blood pressure; Sm = smoking; STEMI = ST-segement elevation myocardia infarction.

Table 2.
PCPS characteristics
Pt. No. Type Cannulation site, artery Arterial catheter size, Fr Cannulation site, vein Venous catheter size, Fr Initial filter type Filter change Change time PCPS duration
1 VA RFA Edward Fem-Flex® 16 RFV Edward 18 C APIOX CX® → CAPIOX CX® 19 36
2 VA RFA 〃 18 RFV Edward 20 〃 – NA 30
3 VA RFA 〃 18 RFV BioMedicus multi-stage® 25 〃 → Quadrox® 68 232
4 VA LFA 〃 18 RFV ″ 25 〃 → Quadrox® 26 97
5 VA RFA 〃 18 RFV ″ 25 〃 – NA 14
          RIJV, Medtronic DLP ®, 17,        
6 VV LFA 〃 16 RIJV, RFV BioMedicus multi-stage® 17, 21 Quadrox® – NA 166
7 VA LFA 〃 16 RFV BioMedicus multi-stage® 25 C APIOX CX® – NA 6
8 VA LFA 〃 16 LFV 〃 25 〃 – NA 93
9 VA LFA 〃 16 LFV 〃 25 〃 – NA 38

Change time = Time from start of PCPS to change (hours); LFA = left femoral artery; NA = not applicable; PCPS = percutaneous cardiopulmonary support; PCPS duration = Duration of PCPS support (hrs); Pt. = patient; RFA = right femoral artery; RFV = right femoral vein; RIJV = right internal jugular vein; VA = venoarterial; VV = veno-veno.

Table 3.
Complications during PCPS
Patient No. Comlications Renal replacement therapy FFP T/F(u) RBC T/F(u) PLT T/F(u) Cryorecipitate (u) Cultured organism (blood)
1 bleeding (GI, Resp) + 16 19 32 12 none
2 none – 10 10 16 12 none
3 bleeding (GI, access site) – 10 7 0 0 none
4 stroke – 0 8 6 0 S. epidermidis
5 None – 0 2 0 0 none
6 hyperbilirubinemia, pneumothorax – 27 17 114 0 none
7 None – 0 8 0 0 None
8 None – 4 1 10 0 None
9 Cannulation site bleeding – 16 20 30 0 K.pneumoniae S.mitis/oralis

FFP = fresh frozen plasma; GI = gastrointestinal; K.pneumoniae = Klebsiella pneumonia; PLT = platelets; RBC = packed red blood cells; Resp = respiratory; S. epidermidis = staphylococcus epidermidis; S.mitis/oralis = Streptococcus mitis/oralis

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