EMERGENCY DEPARTMENT CARDIOPULMONARY BYPASS IN THE TREATMENT OF HUMANCARDIAC-ARREST

Objective: To study the use of emergency department (ED) femoro-femora l cardiopulmonary bypass (CPB) in the resuscitation of medical cardiac arrest patients. Design: Prospective, uncontrolled trial. Setting: Ur ban academic ED staffed with board-certified emergency physicians (EPs ). Participants: Ten patients with medical cardiac arrest unresponsive to standard therapy. Interventions: Femoro-femoral CPB instituted by EPs. Results: The time of cardiac arrest prior to CPB (mean+/-SD) was 32.0+/-13.6 min. The cardiac output while on CPB was 4.09+/-1.03 L/min with an average of 229+/-111 min on bypass. All 10 patients had resum ption of spontaneous cardiac activity while on CPB. Seven of these wer e weaned from CPB with intrinsic spontaneous circulation. Of these, si x patients were transferred from the ED to the operating room for cann ula removal and vessel repair while the other patient died in the ED s oon after discontinuing CPB. Mean survival was 47.8+/-44.7 h in the si x patients leaving the ED. Although these patients had successful hemo dynamic resuscitation, there were no long-term survivors. Conclusion: CPB instituted by EPs is feasible and effective for the hemodynamic re suscitation of cardiac arrest patients unresponsive to advanced cardia c life support therapy. Future efforts need to focus on improving long -term outcome.