The management of non-traumatic cardiac arrest in the operating room with cardiopulmonary bypass

Might rapid implementation of cardiopulmonary bypass in patients who are failing to recover after a cardiac arrest potentially save lives?

The question addressed was whether it might be beneficial to have a rapid-response emergency cardiopulmonary bypass service for patients who suffer an in-hospital or an out-of-hospital cardiac arrest of any aetiology. Eighty-five papers were reviewed using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The concept of using emergency cardiopulmonary bypass (ECPB) for the management of cardiogenic shock and refractory cardiac arrest was developed in the late 1990s. Since this time, a large number of centres worldwide have reported success with use of ECPB for cardiac arrest refractory to conventional resuscitation techniques and for cardiogenic shock. This is a relatively new advancement in resuscitative strategy and is expanding in clinical practice. Clinical studies and experimental data reveal that ECPB is a very effective tool in the return of spontaneous circulation following refractory cardiac arrest. Resuscitation with this technique demonstrated survival benefit when compared with patients having conventional cardiopulmonary resuscitation for >10 min after witnessed in-hospital arrest, especially if the cause of arrest is of cardiac origin. The reported finding from a systematic review of 1494 patients treated with ECPB noted that the overall survival rate was 47.4%; their results indicate that the application of ECPB in cardiac arrest improves survival and the likelihood of a satisfactory neurological outcome. An additional review revealed that acceptable survival rate and neurological outcomes (30%) can be achieved with extracorporeal cardiopulmonary resuscitation in children after prolonged cardiac arrest (up to 95 min) refractory to standard resuscitation. However, no study has provided clear-cut evidence of the merits of ECPS in patients with out-of-hospital cardiac arrest, although many case reports and case series have concluded that it is an effective method. We conclude that institution of emergency cardiopulmonary bypass may save the lives of patients in whom routine attempts at resuscitation after a cardiac arrest fail, especially after >10 min. The likelihood of success is much higher for patients who have in-hospital witnessed cardiac arrest.