Utility of standby cardiopulmonary support for elective coronary interventions

At our institution, elective coronary interventions are performed without f ormal surgical backup. Instead, a policy of "standby cardiopulmonary suppor t" (CPS), and "next-available operating room" is used. Standby CPS requires a perfusionist dedicated to the catheterization laboratory with immediate access to CPS apparatus. Between January 1989 and June 1994 we performed 2, 850 elective coronary interventions. Eleven patients (0.4%) required emerge ncy CPS. None of these patients fell into a high-risk category for PTCA (i. e., sole circulation, ejection fraction <20%, unprotected left main). Eight of these (73%) had completion of their coronary intervention while on CPS in the catheterization laboratory. Three patients were sustained on CPS unt il an operating room became available. All patients required blood transfus ions and sustained non-Q-wave myocardial infarctions. Two late in-hospital deaths occurred. Nine patients (82%) were successfully discharged. Standby CPS provides hemodynamic support for patients who sustain a potentially cat astrophic event during coronary intervention. Our data suggest that this mo dality should not be limited to high-risk patients. (C) 1999 Wiley-Liss, In c.