Initial Experience of the Emergency Bypass System (EBS(R)) for the Patients with Cardiogenic Shock due to an Acute Myocardial Infarction

Ryu, Kyoung Min; Kim, Sam Hyun; Seo, Pil Won; Ryu, Jae Wook; Kim, Seok Kon; Kim, Young Hwa; Park, Seongsik

Abstract

BACKGROUND: Percutaneous cardiopulmonary support (PCPS) has the potential to rescue patients in cardiogenic shock who might otherwise die. PCPS has been a therapeutic option in a variety of the clinical settings such as for patients with myocardial infarction, high-risk coronary intervention and postcardiotomy cardiogenic shock, and the PCPS device is easy to install. We report our early experience with PCPS as a life saving procedure in cardiogenic shock patients due to acute myocardial infarction. MATERIAL AND METHOD: From January 2005 to December 2006, eight patients in cardiogenic shock with acute myocardial infarction underwent PCPS using the CAPIOX emergency bypass system (EBS(R), Terumo, Tokyo, Japan). Uptake cannulae were inserted deep into the femoral vein up to the right atrium and return cannulae were inserted into the femoral artery with Seldinger techniques using 20 and 16-French cannulae, respectively. Simultaneously, autopriming was performed at the EBS(R) circuit. The EBS? flow rate was maintained between 2.5~3.0 L/min/m2 and anticoagulation was performed using intravenous heparin with an ACT level above 200 seconds. RESULT: The mean age of patients was 61.1+/-14.2 years (range, 39 to 77 years). Three patients were under control of the EBS? before percutaneous coronary intervention (PCI), three patients were under control of the EBS? during PCI, one patient was under control of the EBS after PCI, and one patient was under control of the EBS(R) after coronary bypass surgery. The mean support time was 47.5+/-27.9 hours (range, 8 to 76 hours). Five patients (62.5%) could be weaned from the EBS(R) after 53.6+/-27.2 hours (range, 12 to 68 hours) of support. All of the patients who could successfully be weaned from support were discharged from the hospital. There were three complications: one case of gastrointestinal bleeding and two cases of acute renal failure. Two of the three mortality cases were under cardiac arrest before EBS(R) support, and one patient had an intractable ventricular arrhythmia during the support. All of the discharged patients are still surviving at 16.8+/-3.1 months (range, 12 to 20 months) of follow-up.
CONCLUSION
The use of EBS(R) for cardiogenic shock caused by an acute myocardial infarction could rescue patients who might otherwise have died. Successfully recovered patients after EBS(R) treatment have survived without severe complications. More experience and additional clinical investigations are necessary to elucidate the proper installation timing and management protocol of the EBS? in the future.