Emergent percutaneous cardiopulmonary bypass in patients having cardiovascular collapse in the cardiac catheterization laboratory

David W. Grambow, G. Michael Deeb, Gregory S. Pavlides, Ann Margulis, William W. O'Neill, Eric R. Bates

Research output: Contribution to journalArticle

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Abstract

Percutaneous cardiopulmonary bypass (PCB) was instituted in 30 initially stable patients who developed either cardiac arrest refractory to resuscitation (n = 7) or cardiogenic shock (mean arterial blood pressure <50 mm Hg unresponsive to fluid resuscitation or vasopressors) (n = 23) after a cathetertzation laboratory complication. Events leading to collapse included abrupt closure during percutaneous transluminal coronary angioplasty (PTCA) (n = 22), complications from diagnostic cardiac catheterization (n = 6), left ventricular perforation during mural valvuloplasty (n = 1), and right ventricular perforation during pericardiocentesis (n = 1). PCB was initiated within 20 minutes of cardiovascular collapse in 83% of patients (arrest: 21 ± 13 minutes [range 10 to 50]; and shock: 17 ± 6 minutes [range 10 to 30]). Mean arterial blood pressure increased on PCB from 0 to 56 mm Hg in patients with cardiac arrest and from 37 to 63 mm Hg in those with cardiogenic shock at mean PCB flow rates of 2.5 to 5.0 liters/min. Subsequent therapy on PCB included emergent cardiac surgery (n = 14), PTCA (n = 13) and medical therapy (n = 3). Six patients (20%) survived to hospital discharge (3 with cardiac surgery, 2 with PTCA, and 1 with medical therapy). All 7 patients with refractory cardiac arrest died despite further interventions on PCB, whereas 6 of 23 (26%) with cardiogenic shock survived to hospital discharge. Thus, in response to cardiovascular collapse in the catheterization laboratory, PCB does not salvage patients who do not regain a stable cardiac rhythm. PCB can stabilize patients who develop cardiogenic shock for further interventions which are lifesaving in only a minority of patients.

Original languageEnglish (US)
Pages (from-to)872-875
Number of pages4
JournalThe American Journal of Cardiology
Volume73
Issue number12
DOIs
StatePublished - May 1 1994

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Cardiac Catheterization
Cardiopulmonary Bypass
Cardiogenic Shock
Coronary Balloon Angioplasty
Arterial Pressure
Heart Arrest
Resuscitation
Thoracic Surgery
Pericardiocentesis
Catheterization
Shock
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Emergent percutaneous cardiopulmonary bypass in patients having cardiovascular collapse in the cardiac catheterization laboratory. / Grambow, David W.; Michael Deeb, G.; Pavlides, Gregory S.; Margulis, Ann; O'Neill, William W.; Bates, Eric R.

In: The American Journal of Cardiology, Vol. 73, No. 12, 01.05.1994, p. 872-875.

Research output: Contribution to journalArticle

Grambow, David W. ; Michael Deeb, G. ; Pavlides, Gregory S. ; Margulis, Ann ; O'Neill, William W. ; Bates, Eric R. / Emergent percutaneous cardiopulmonary bypass in patients having cardiovascular collapse in the cardiac catheterization laboratory. In: The American Journal of Cardiology. 1994 ; Vol. 73, No. 12. pp. 872-875.
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