Factors for Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Severe Cardiac Failure A Comparative Study in Weaned and Nonweaned Patients

Abstract

SUMMARYThe percutaneous cardiopulmonary support system (PCPS) has been widely accepted for the treatment of patients with severe cardiac failure. This system, which uses Seldinger's method through a percutaneous approach, enables rapid application in emergency situations. However, the indication for deployment and discontinuation of PCPS has not yet been established. We evaluated the results of PCPS use for the treatment of patients with severe cardiac failure and investigated factors that would predict successful weaning from PCPS.A total of 32 patients (23 men and 9 women) who had PCPS for the treatment of severe cardiac failure between January 1997 and October 2004 were retrospectively reviewed. The mean age of the patients was 57 ± 17 years (range, 14 to 78 years). PCPS was necessary for severe cardiac failure after cardiac surgery in 15 patients, pulmonary infarction in 4, acute myocardial infarction in 3, acute myocarditis in 3, and other causes in 7.The mean duration of PCPS support in all 32 patients was 134 ± 117 hours (range, 8 to 532). Twelve patients (38%) could be weaned from PCPS (group A), while the remaining 20 patients (62%) could not (group B). The incidence of cardiac arrest prior to PCPS use (n = 10, 31%) was significantly (P < 0.05) lower in group A (1/12, 8%) than in group B (9/20, 45%). There were significant differences in the APACHE II scores, urine output, serum lactate levels, and epinephrine and dopamine dose received from PCPS induction to 72 hours after PCPS use between the 2 groups (P < 0.05). Multivariate logistic regression analysis showed that an episode of cardiac arrest prior to PCPS induction was the only significant predictor for the unsuitability for discontinuation of PCPS.This retrospective study showed the limitation of PCPS therapy for patients with an episode of cardiac arrest who did not show improvement in their APACHE II score, urine output, serum lactate levels, and catecholamine dose received within 72 hours after PCPS induction. These results may help formulate criteria for indication and discontinuation of From the

Fulminant Type 1 Diabetes Mellitus and Fulminant Viral Myocarditis

“…Since circulatory deterioration by myocarditis might depend not only on cardiomyocyte injury but also on interstitial edema or fibrosis, 1,2) the mild elevation of the myocardial enzyme in our patient probably reflected relatively mild cardiomyocyte injury and was related to successful treatment with relatively short-term mechanical circulatory support. 31) In conclusion, we reported a case of concurrent FT1D and fulminant viral myocarditis. Viral myocarditis that is accompanied by the onset of FT1D might become clinically evident after correcting ketoacidosis, even when ECG abnormalities are not detected before ketoacidosis treatment.…”

Predictive factors for successful weaning from percutaneous cardiopulmonary support in patients with cardiogenic shock complicating acute myocardial infarction

“…We demonstrated that patients who could be weaned from PCPS required a lower flow rate of PCPS support to maintain systemic circulation at the 24th hour of PCPS treatment. Oshima et al reported that the PCPS flow was reduced 72 h after the initiation of PCPS in patients who could be successfully weaned from PCPS [27]. Their study enrolled patients who experienced severe cardiac failure due to various causes, including postcardiac surgery, pulmonary thrombosis, AMI, and acute myocarditis.…”

“…Weaning from PCPS is often difficult and not always successful due to the complications mentioned above, and therefore, the appropriate discontinuation of PCPS is a critical problem [22,23]. Several reports found that appropriate adjustment of the support flow rate after the initiation of PCPS facilitates the recovery of cardiac function and subsequently contributes to prevent the complications associated with PCPS [24][25][26][27]. To date, there have been no guidelines established for the use of PCPS, nor have methods been established for successful weaning from PCPS.…”

Factors for Successful Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Low Cardiac Output Syndrome After Cardiovascular Surgery

“…Thirteen patients (1.4%) required PCPS within 48 hours after surgery to maintain hemodynamic stability. The indication for PCPS for severe cardiac failure in our hospital is as follows: 5) peak systolic pressure of less than 80 mmHg and a cardiac index of less than 1.8 L/min/m 2 for more than 30 minutes after correction for hypovolemia, hypoxemia, and acidosis. A decrease in cardiac output unresponsive to intra-aortic balloon pumping (IABP), and patients in whom CPB could not be Vol 48 No 6 discontinued immediately after cardiovascular surgery were also indicated for PCPS.…”