Emergency cardiopulmonary bypass in the cardiac surgical unit can be a lifesaving measure in postoperative cardiac arrest

Abstract

Background: Postoperative cardiac arrest that is not responsive to conventional resuscitation is uniformly fatal. Sixteen patients who experienced postoperative ventricular fibrillation (VF) and arrest over a 6-year period and did not respond to open chest resuscitation were placed on an emergency basis on cardiopulmonary bypass (CPB) in the cardiac surgical intensive care unit (CSICU).

Methods and results: Data were reviewed by retrospective analysis. Nine of the 16 patients (56.3%) survived, and they spent a mean of 9 +/- 2.8 days in the CSICU and a mean of 17 +/- 4.6 days in the hospital. They all are alive 1 month to 5 1/2 years later. The mean interval between VF/arrest and CPB in the CSICU was 50 +/- 6.7 minutes (range, 25 to 83 minutes) for survivors and 51 +/- 6.1 minutes (35 to 83 minutes) for nonsurvivors (P = .98). The duration of CPB in the CSICU was 111 +/- 16.0 minutes (range, 55 to 189 minutes) for survivors and 167 +/- 20.7 minutes (range, 80 to 232 minutes) for nonsurvivors (P = .05). There were no apparent differences between survivors and nonsurvivors in age, history of arrhythmias, use of antiarrhythmics, congestive heart failure, recent myocardial infarction, ejection fraction, preoperative intra-aortic balloon pump, urgency, or type of operation. Surgical variables and postoperative medications and electrolytes (after the primary procedure) were similar. The use of cardioplegic arrest during CPB in the CSICU was higher among survivors (3 of 9) compared with 0 of 7 for nonsurvivors (P = .21). There was no mediastinitis and only two minor soft tissue infections among survivors.

Conclusions: The use of CPB in the CSICU can achieve significant survival in patients who have otherwise irreversible cardiac arrest and/or VF after surgery; the incidence of infection in patients undergoing CPB in the CSICU is very low; and the use of warm cardioplegic arrest may enhance the changes of survival in this type of patient.