Earlier Application of Percutaneous Cardiopulmonary Support Rescues Patients from Severe Cardiopulmonary Failure Using the APACHE III Scoring System.
10.3346/jkms.2009.24.6.1064
- Author:
Suk Won SONG
1
;
Hong Suk YANG
;
Sak LEE
;
Young Nam YOUN
;
Kyung Jong YOO
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Extracorporeal Membrane Oxygenation;
Outcomes
- MeSH:
*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
- From:Journal of Korean Medical Science
2009;24(6):1064-1070
- CountryRepublic of Korea
- Language:English
-
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.
