THE DETERMINANT OF SEVERE CEREBRAL-DYSFUNCTION IN PATIENTS UNDERGOINGEMERGENCY EXTRACORPOREAL LIFE-SUPPORT FOLLOWING CARDIOPULMONARY-RESUSCITATION

We investigated the factors associated with cerebral dysfunction in pa tients undergoing extracorporeal life support (ECLS) following convent ional advanced cardiac life support (ACLS). The subjects were 9 patien ts in whom ECLS was started following ACLS because of intractable card iac arrest. We investigated whether the irreversibility of cerebral dy sfunction during ECLS was related to the cardiopulmonary resuscitation (CPR) time, arterial pH and blood gases, hemoglobin concentration (Hb ), peak arterial pressure (PAP) before the start of ECLS and total dos es of epinephrine and sodium bicarbonate administered during CPR. Two of the 3 patients who recovered consciousness were weaned from ECLS an d survived, while all 6 patients who did not recover from coma were no t weaned and died. There was no difference in the CPR time, Hb and PAP before the start of ECLS along with total doses of epinephrine and so dium bicarbonate administered during CPR between the patients who reco vered consciousness and those who did not. In addition, there was no d ifference in arterial pH and blood gases except the arterial oxygen te nsion (Pao(2)) between the groups. The Pao(2) values before the start of ECLS in the patients who remained in coma ranged from 34 to 58 mmHg , whereas those in the patients who recovered consciousness ranged fro m 132 to 442 mmHg. The Pao(2) values before the start of ECLS in the p atients who remained in coma were less than 60 mmHg, whereas those in the patients who recovered consciousness were over 60 mmHg. The presen t study suggests that hypoxemia during CPR may play a major role in se vere cerebral dysfunction in patients undergoing ECLS. Further investi gations are needed to determine the relationship between severe cerebr al dysfunction in patients undergoing ECLS and Pao, during CPR.