What are the appropriate indications for use of a percutaneous cardiopulmonary support system in patients with acute circulatory failure?

Abstract

The purpose of this study was to determine the appropriate indications for the use of a percutaneous cardiopulmonary support system (PCPS) for patients with acute circulatory failure. We studied 43 consecutive patients who used PCPs because of acute circulatory failure. We compared clinical characteristics between the two groups (weaning: n=14, and non-weaning: n=29) and examined the factors related to successful weaning from PCPS. We used a shock scoring system (shock score) for evaluating the severity of shock from five clinical factors such as systolic blood pressure, heart rate, hourly urinary output, base excess and mental state before using PCPS. There were no significant differences between the two groups in the basal disease or the time elapsed from the onset of shock to starting PCPS. Shock scores were significantly higher in the non-weaning group than in the weaning group (9.8±2.3 vs. 6.7±2.8; P<0.001). The incidence of cardiac arrest or fatal arrhythmias before using PCPS was significantly higher in the non-weaning group than in the weaning group (72% vs. 36%; P<0.05). All the patients whose shock scores were greater than 11 could not be weaned from PCPS. The patients with mild or moderate acute circulatory failure whose shock scores were less than 10 could be weaned from PCPS. Thus PCPS should be used before the shock state falls into hemodynamic collapse.