Abstract 2010: A Pre-hospital Percutaneous Cardiopulmonary Bypass Order Treatment Strategy Significantly Improves Neurological Function in Patients with Out-of-Hospital Cardiogenic Cardiopulmonary Arrest

Abstract

Objectives: Percutaneous cardiopulmonary bypass (PCPB) is a powerful tool for rescuing the emergency patients (pts) with out-of-hospital cardiogenic cardiac arrest (OHCCA), who are not responding to advanced cardiovascular life support (ACLS). But the system under which the decision to apply PCPB is made at the hospital and preparations then made could exceed the time limitations imposed for cerebral resuscitation. Thus, we have collaborated with the physician-manned ambulance system, and we introduced a pre-hospital PCPB order treatment strategy for patients with out-of-hospital cardiogenic cardiopulmonary arrest, who do not respond to drug administration or electrical cardioversion. Methods: In 174 pts with OHCA treated with PCPB in a single institution, from April 1991 to May 2007. 135 consecutive pts with cardiogenic cardiac arrest refractory to ACLS, who had been treated with PCPB, were included. 135 Pts were divided into two groups. Pre-hospital order groups (n=42) were treated under the pre-hospital PCPB order system, and in-hospital order groups (n=93) were treated under the decision to initiate PCPB was made at the hospital. Rate of return of spontaneous circulation (ROSC), weaning of PCPB, survival to discharge, and favorable neurological recovery were assessed. Results: Pre-hospital order groups showed increases in ROSC, weaning of PCPB, survival to discharge, and significant increases in favorable neurological recovery compared to in-hospital order groups. Conclusions: These results suggest that a pre-hospital PCPB order treatment strategy for patients after CPA significantly improves the neurological function in pts with OHCCA. Table