J Korean Med Sci.  2009 Dec;24(6):1064-1070. 10.3346/jkms.2009.24.6.1064.

Earlier Application of Percutaneous Cardiopulmonary Support Rescues Patients from Severe Cardiopulmonary Failure Using the APACHE III Scoring System

• Song SW
• Yang HS
• Lee S
• Youn YN
• Yoo KJ

• KMID: 1783134
• DOI: http://doi.org/10.3346/jkms.2009.24.6.1064

Abstract

Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score > or =50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores > or =50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival.

Keyword

Extracorporeal Membrane Oxygenation; Outcomes

MeSH Terms

*APACHE
Adult
Aged
Aged, 80 and over
*Cardiopulmonary Resuscitation/methods/utilization
Catecholamines/therapeutic use
Female
Heart Failure/mortality/*therapy
Hospital Mortality
Humans
Male
Middle Aged
Regression Analysis
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome

Figure

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  Fig. 1 Serial catecholamine dose administered during PCPS to survivors and nonsurvivors. (A) Dopamine, (B) Dobutamine. The two groups did not differ significantly using a repeated generalized linear model (P>0.05).

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  Fig. 2 Serial catecholamine dose administered during PCPS to survivors and non-survivors. (A) Epinephrine, (B) Norepinephrine. The two groups did not differ significantly using a repeated generalized linear model (P>0.05)

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  Fig. 3 Serial APACHE III scores during PCPS of survivors and non-survivors. The two groups differed significantly using a repeated generalized linear model (P=0.025).

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  Fig. 4 Overall survival in patients with PCPS relative to initial APACHE III scores. Overall survival at 18 months was 87.5% for patients with APACHE scores <50 and 28.8% for patients with APACHE III scores ≥50 (P=0.001).

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