Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital

OBJECTIVES The purpose of this study was to evaluate the efficacy of an alt ernative cardiopulmonary cerebral resuscitation (CPCR) using emergency card iopulmonary bypass (CPB), coronary reperfusion therapy and mild hypothermia . BACKGROUND Good recovery of patients with out-of-hospital cardiac arrest is still inadequate. An alternative therapeutic method for patients who do no t respond to conventional CPCR is required. METHODS A prospective preliminary study was performed in 50 patients with o ut-of-hospital cardiac arrest meeting the inclusion criteria. Patients were treated with standard CPCR and, if there was no response, by emergency CPB plus intra-aortic balloon pumping. Immediate coronary angiography for coro nary reperfusion therapy was performed in patients with suspected acute cor onary syndrome. Subsequently, in patients with systolic blood pressure abov e 90 mm I-Ig and Glasgow coma scale score of 3 to 5, mild hypothermia (34 d egrees C for at least two days) was induced by coil cooling. Neurologic out come was assessed by cerebral performance categories at hospital discharge. RESULTS Thirty-six of the 50 patients were treated with emergency CPB, and 30 of 39 patients who under;vent angiography suffered acute coronary artery occlusion. Return of spontaneous circulation and successful coronary reper fusion were achieved in 92% and 87%, respectively. Mild hypothermia could b e induced in 23 patients, and 12 (52%) of them showed good recovery. Factor s related to a good recovery were cardiac index in hypothermia and the pres ence of serious complications with hypothermia or CPB. CONCLUSIONS The alternative CPCR demonstrated an improvement in the inciden ce of good recovery. Based upon these findings, randomized studies of this hypothermia are needed. (C) 2000 by the American College of Cardiology.