Percutaneous Cardiopulmonary (Bypass) Support in the Cardiac Catheterization Laboratory: A New Application of Perfusion

Abstract

Percutaneous cardiopulmonary bypass support (PCPS) has been introduced in the catheterization laboratory to support high risk coronary angioplasty, as well as emergencies. We report the safety and feasibility of PCPS in 45 patients. Thirty-seven patients (Group 1) were elective and eight were emergencies (Group 2). Group 1 (ages 41-82) were high risk coronary angioplasty, Group 2 (ages 40-82) were in cardiogenic shock due to myocardial infarction with two in cardiac arrest. Cannulation of femoral artery and vein was with 20 French cannulae. Priming of the system with 1400 ml of Normosol was achieved in 5-7 minutes. Cardiopulmonary bypass was then instituted using the Bard CPS system after full heparinization (300 units per kilogram). Flows ranged from 2.8-5.5 liters per minute (mean-3.8) and pulmonary diastolic pressures were 0-4 mm Hg. Two patients in cardiac arrest regained consciousness while still in ventricular fibrillation or asystole. The activated clotting time ranged from 317-880 seconds (mean=498). Mean bypass time was 37 minutes (range 10-73) in Group 1 and 66 minutes (range 44-120) in Group 2. Total infusion volume of Normosol during and prior to termination of bypass was 0-2500 cc (mean=338). There were no procedural complications associated with PCPS. We conclude that PCPS can be used safely in selected patients who are considered high risk for PICA or acute MI complicated by shock or cardiac arrest. This technology adds a new dimension in perfusion in the catheterization laboratory.