Abstract 2052: A Rapid Cooling of The Brain Using Percutaneous Cardiopulmonary Bypass Significantly Improves Neurological Function in Patients with Out-of-Hospital Cardiogenic Cardiac Arrest

Abstract

Objectives: Neurological recovery in patients (pts) with out-of-hospital cardiogenic cardiac arrest (OHCCA) is affected by the cerebral circulatory collapse time from the cardiac arrest to the return of spontaneous circulation. According to recent studies, the cerebral circulatory collapse time is estimated to be 30 min. or less in order to successfully recover neurologically. In addition, percutaneous cardiopulmonary bypass (PCPB) is a powerful tool for rescuing the pts with OHCCA refractory to advanced cardiovascular life support (ACLS), and we have been positively performing cardiopulmonary cerebral resuscitation and rapidly cooling of the brain using PCPB. In this treatment, the cerebral circulatory collapse time is the duration from cardiac arrest to the start of PCPB, we discovered the fact that there are many neurologically successful cases of recovery even though the cerebral circulatory collapse time has exceeded 30 min. In the present study, we investigated the neurological prognosis in relation to the cerebral circulatory collapse time. Methods: From January 2006 to April 2008, 77 consecutive pts with OHCCA, who have been treated with brain hypothermia at 34 degree C were included. 77 pts were divided into two groups. Brain hypothermia (BH) groups (n=34) were treated with only brain hypothermia after the return of spontaneous circulation, and PCPB groups (n=33) were treated with hypothermia using PCPB against refractory to ACLS. The relation between the cerebral circulatory collapse time and the neurological prognosis were assessed. Results: The cerebral circulatory collapse time were from 8 min. to 78 min. in the BH groups, whereas it lasted from 22 min. to 91 min. in PCPB groups. In BH groups, the cases with the favorite neurological outcome were 23 cases (67.6%) and the average collapse time was 19.2 min. (8 to 35 min.) In contrast, in the PCPB groups, the successful neurological cases were 15 cases (45.5%), the average collapse time was 43.6 min (22 to 60 min.) In the cases who received PCPB, there were cases of neurologically successful prognoses even though the cerebral circulatory collapse time was long. Conclusions: These results suggest that a rapid cooling of the brain using PCPB permits a cerebral circulatory collapse time.