Prognostic factors of percutaneous cardiopulmonary support therapy at Osaka City General Hospital, Japan

Objective

The aim of our study was to investigate the prognostic factors in patients with cardio and/or respiratory failure who received percutaneous cardiopulmonary support (PCPS) therapy in the ICU.

Materials and methods

The population was a total of 148 patients (105 adults, 13 children, 30 newborn infants) who received PCPS therapy from July 1994 to June 2004. We evaluated the patients' ages, clinical characteristics, the number of days of PCPS therapy, PaO₂/FiO₂, and hemodynamic parameters, including base excess at the time of discontinuing PCPS. We classified the cases into five groups considering the clinical characteristics: cardiac disease, non-cardiac disease including acute respiratory failure, postoperative cardiac failure, congenital heart disease and operation-assisted cases (n = 58, n = 38, n = 18, n = 28 and n = 6, respectively).

Results

Seventy-three of the 148 patients could be taken off PCPS; however, 37 of those 73 patients died within 4 weeks after removing the PCPS. The mortality was 76% (adults 78%, children 61%, newborn infants 90%). In 104 adult patients, those who required PCPS for more than 7 days exhibited significantly poor prognosis. In the five groups, mortality was 67%, 76%, 95%, 89% and 33%, respectively. Patients who had less than -2 on the base excess level and less than 200 on the PaO₂/FiO₂ level when the PCPS was removed had significantly poor prognoses.

Conclusions

A low PaO₂/FiO₂, a low base excess and a long course of PCPS therapy are very poor prognostic indicators in patients receiving PCPS therapy. PCPS therapy has been proven effective in acute respiratory and cardiac failure cases, but we suggest that PCPS therapy has to be carefully limited considering all the clinical characteristics because the mortality rate is still so high.