PERCUTANEOUS CARDIOPULMONARY SUPPORT AS THE 2ND GENERATION OF VENOARTERIAL BYPASS - CURRENT STATUS ARN-D FUTURE-DIRECTION

We have developed a new percutaneous cardiopulmonary support (PCPS) sy stem in cooperation with Terumo Corporation, called the Emergency Bypa ss System (EBS). This preassembled system is unique in terms of its sm all priming volume (470 cc), fully automatic priming function, origina lly developed membrane oxygenator, and Capiox straight path centrifuga l pump. The priming process takes only 5 min. We have used this system in 4 patients (all were male; mean age 56 years, range 35-73 years). The duration of assist ranged from 15 min to 210 h. Maximum bypass flo w ranged from 2.2 to 3.6 L/min, systemic circulation was very well mai ntained, and urinary output was acceptable. Although the centrifugal p ump was in good working condition, we had to change the oxygenator bec ause of serum leakage 36 to 48 h after initiation of the assist. One p atient was weaned from the PCPS, but died of brain death. The other pa tients could not be weaned from the PCPS. The cause of death in these patients was irreversible myocardial damage. Disseminated intravascula r coagulopathy triggered by surgical trauma related to various procedu res developed in 2 patients during assist and was the cause of cessati on of the assist. Problems to be ratified and future directions in the EBS and PCPS were earlier introduction through the establishment of c lear indications and endpoint, heparin coating, improvement in durabil ity of the oxygenator, and cost.