Abstract
After cardiac arrest (no flow) of more than approximately 5 minutes' duration, standard external cardiopulmonary resuscitation (CPR) basic, advanced, and prolonged life support (BLS, ALS, PLS) do not reliably produce cerebral and coronary perfusion pressures to maintain viability and achieve stable spontaneous normotension; nor do they provide prolonged control over pressure, flow, composition, and temperature of blood. Since these capabilities are often needed to achieve conscious survival, emergency closed-chest cardiopulmonary bypass (CPB) by veno-arterial pumping via oxygenator is presented in this review as a potential addition to ALS-PLS for selected cases. In six dog studies by the Pittsburgh group (n = 211; 1982 through 1988), all 179 dogs that received CPB after prolonged cardiac arrest (no flow) or after CPR (low flow) states had restoration of stable spontaneous circulation. The use of CPB enhanced survival and neurological recovery over those achieved with CPR-ALS attempts only. With CPB and standard intensive care, it was possible to reverse normothermic ventricular fibrillation (VF) cardiac arrest (no flow) of up to 15 minutes and to achieve survival without neurologic deficit; VF of 20 minutes to achieve survival but with neurologic deficit; and VF of 30 minutes to achieve transient restoration of spontaneous circulation followed by secondary cardiac death. CPB could restore stable spontaneous circulation after ice water submersion of up to 90 minutes. Other groups' laboratory and clinical results agree with these findings in general. Clinical feasibility trials are needed to work out logistic problems and to meet clinical challenges. Future possibilities for emergency CPB require further research and development.
| Original language | English |
|---|---|
| Pages (from-to) | 55-67 |
| Number of pages | 13 |
| Journal | American Journal of Emergency Medicine |
| Volume | 8 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 1990 |
| Externally published | Yes |
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Keywords
- Artificial circulation
- cardiac arrest
- cardiopulmonary bypass
- cardiopulmonary resuscitation
- cerebral ischemia
- cerebral resuscitation
- extracorporeal membrane oxygenation
- resuscitation
ASJC Scopus subject areas
- Emergency Medicine
Cite this
Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest. / Safar, Peter; Abramson, Norman S.; Angelos, Mark; Cantadore, Rinaldo; Leonov, Yuval; Levine, Robert; Pretto, Ernesto; Reich, Harvey; Sterz, Fritz; Stezoski, S. William; Tisherman, Samuel.
In: American Journal of Emergency Medicine, Vol. 8, No. 1, 01.01.1990, p. 55-67.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest
AU - Safar, Peter
AU - Abramson, Norman S.
AU - Angelos, Mark
AU - Cantadore, Rinaldo
AU - Leonov, Yuval
AU - Levine, Robert
AU - Pretto, Ernesto
AU - Reich, Harvey
AU - Sterz, Fritz
AU - Stezoski, S. William
AU - Tisherman, Samuel
PY - 1990/1/1
Y1 - 1990/1/1
N2 - After cardiac arrest (no flow) of more than approximately 5 minutes' duration, standard external cardiopulmonary resuscitation (CPR) basic, advanced, and prolonged life support (BLS, ALS, PLS) do not reliably produce cerebral and coronary perfusion pressures to maintain viability and achieve stable spontaneous normotension; nor do they provide prolonged control over pressure, flow, composition, and temperature of blood. Since these capabilities are often needed to achieve conscious survival, emergency closed-chest cardiopulmonary bypass (CPB) by veno-arterial pumping via oxygenator is presented in this review as a potential addition to ALS-PLS for selected cases. In six dog studies by the Pittsburgh group (n = 211; 1982 through 1988), all 179 dogs that received CPB after prolonged cardiac arrest (no flow) or after CPR (low flow) states had restoration of stable spontaneous circulation. The use of CPB enhanced survival and neurological recovery over those achieved with CPR-ALS attempts only. With CPB and standard intensive care, it was possible to reverse normothermic ventricular fibrillation (VF) cardiac arrest (no flow) of up to 15 minutes and to achieve survival without neurologic deficit; VF of 20 minutes to achieve survival but with neurologic deficit; and VF of 30 minutes to achieve transient restoration of spontaneous circulation followed by secondary cardiac death. CPB could restore stable spontaneous circulation after ice water submersion of up to 90 minutes. Other groups' laboratory and clinical results agree with these findings in general. Clinical feasibility trials are needed to work out logistic problems and to meet clinical challenges. Future possibilities for emergency CPB require further research and development.
AB - After cardiac arrest (no flow) of more than approximately 5 minutes' duration, standard external cardiopulmonary resuscitation (CPR) basic, advanced, and prolonged life support (BLS, ALS, PLS) do not reliably produce cerebral and coronary perfusion pressures to maintain viability and achieve stable spontaneous normotension; nor do they provide prolonged control over pressure, flow, composition, and temperature of blood. Since these capabilities are often needed to achieve conscious survival, emergency closed-chest cardiopulmonary bypass (CPB) by veno-arterial pumping via oxygenator is presented in this review as a potential addition to ALS-PLS for selected cases. In six dog studies by the Pittsburgh group (n = 211; 1982 through 1988), all 179 dogs that received CPB after prolonged cardiac arrest (no flow) or after CPR (low flow) states had restoration of stable spontaneous circulation. The use of CPB enhanced survival and neurological recovery over those achieved with CPR-ALS attempts only. With CPB and standard intensive care, it was possible to reverse normothermic ventricular fibrillation (VF) cardiac arrest (no flow) of up to 15 minutes and to achieve survival without neurologic deficit; VF of 20 minutes to achieve survival but with neurologic deficit; and VF of 30 minutes to achieve transient restoration of spontaneous circulation followed by secondary cardiac death. CPB could restore stable spontaneous circulation after ice water submersion of up to 90 minutes. Other groups' laboratory and clinical results agree with these findings in general. Clinical feasibility trials are needed to work out logistic problems and to meet clinical challenges. Future possibilities for emergency CPB require further research and development.
KW - Artificial circulation
KW - cardiac arrest
KW - cardiopulmonary bypass
KW - cardiopulmonary resuscitation
KW - cerebral ischemia
KW - cerebral resuscitation
KW - extracorporeal membrane oxygenation
KW - resuscitation
UR - http://www.scopus.com/inward/record.url?scp=0025210459&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025210459&partnerID=8YFLogxK
U2 - 10.1016/0735-6757(90)90298-E
DO - 10.1016/0735-6757(90)90298-E
M3 - Article
C2 - 2403478
AN - SCOPUS:0025210459
VL - 8
SP - 55
EP - 67
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 1
ER -