Cardiopulmonary resuscitation with cardiopulmonary bypass after cardiac surgery

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Background

Emergency cardiopulmonary bypass (CPB) can be life-saving in cardiac arrest (CA) after cardiac surgery, when cardiopulmonary resuscitation (CPR) and open chest massage do not suffice. Outcome of these patients is, however, questionable. A retrospective study on these patients was done to investigate predictors of survival.

Material and methods

From January 1995 to October 1999, 18 patients experienced CA or ventricular fibrillation (VF) after a cardiac surgical procedure, refractory to CPR and open chest massage (i.e. 0.7% of our total adult cardiac surgery population). Mean age was 64.8 years (range 36-75) with 14/18 male patients. Preceding operative procedure was coronary artery bypass graft (CABG) (n=1), urgent redo CABG (n=2), ascending aorta replacement for dissection (n=1). CA most often occurred some hours after surgery in intensive care (n=14), or with the patient still in the operation theatre (n=3). Duration of CPR is therefore always less than 1 hour. All patients were immediately put on conventional CPB. Events leading to CA were ischemia (n=11), bleeding with or without tamponade (n=3), aortic dissection, electromechanical dissociation, right ventricular failure or shock (each in 1 patient). In 8 of the 11 patients with ischemia, redo CABG was performed. In the other patients (n=7), bleeding sites were handled or reperfusion was given.

Results

Of 8 patients with redo CABG as a resuscitative procedure, 5 could be weaned from CPB with or without intra-aortic balloon pumping (IABP) and survived. The remaining 3 patients were put on IABP (n=1) or biventricular assist device (BVAD) (n=2), but died. Three patients with reperfusion for ischemia did not survive, despite IABP (n=2) or BVAD (n=1). Of 7 patients without ischemia, only 2 survived.

Postoperative complications in the 7 surviving patients (38%) were pneumonia (n=5), renal failure with hemodialysis (n=3), slow neurological recovery (n=1). Hospital length of stay was 20.5 days (range 5-43). All but one patient are still in good health (mean follow up 26 months).

Conclusion

The incidence of CPR necessitating emergency CPB was low. Only aggressive treatment with emergent bedside resternotomy and CPB can save one third of these patients. Best results were achieved when a correctable cause for the CA was identified.