739-6 Emergency Cardiopulmonary Support in Cardiac Arrest and Cardiogenic Shock: Enhanced Survival from the Registry

Despite thorough training in advanced cardiac life support, treatment of cardiac arrest (CA) and cardiogenic shock (CS) has not increased survival rates from in-hospital catastrophes. This report of the National Registry for Emergency Cardiopulmonary Bypass (CPS) describes outcomes in 258 consecutive patients (pts) treated at the participating institutions.Of these pts, 173 had initial CA and 77 presented with CS uresponsive to pressors. Eight were in other categories including a frozen aortic valve prosthesis, embolic stroke, dissection, papillary muscle rupture, tamponade, ventricular-tachycardia, subtotal left main with electromechanical dissociation. CPS placement occurred: cath lab (N=185). Emergency room (N=10), Intensive Care Unit (N=25), Ward (N=9), and other (N=29).Etiology of CAN%Survivors%Myocardial Infarction70/17340%18/7026%Post Bypass Graft Surgery8/1735%3/838%Angioplasty Failure67/17339%25/6737%Trauma3/1731%0/30%Pulmonary Emboli10/1736%1/1010%Other15/1739%6/1540%34% (89/258) of all pts survived. When flow was established on CPS in < 20 minutes, 80/208 (38%) survived. When flow was established in < 20 minutes only 9/50 pts (18%) survived; 6 of these 9 pts (67%) had flow established in 20–25 minutes. Pts who had CPS placed in the cath lab resulted in 41% survivorship (76/185).Of the 258 pts treated, 118 were sent to emergency surgery. Of these, 50/118 (42%) survived to hospital discharge.ConclusionsCPS is a justifiable technique for selected pts in CA or refractory CS particularly in the cardiac cath lab. Complete surgical revascularization post CPS may offer even better survivorship