The Experimental Study Of Emergency Cardio-pulmonary Bypass By Percutaneous Puncture In Cardio-pulmonary Resuscitation

Introduction: The percutaneous cardiopulmonary bypass (PCPB), one kind of CPB , also named percutaneous cardiopulmonary support (PCPS), is an auxiliary circulation support system at bedside under local anesthesia and non-open-thorax. Catheter is inserted into right atrium by percutaneous cannulation via periphery large vein and venous blood is drained to artificial pump. After oxygenation, the oxygenated blood is pumped into periphery large artery. PCPS can partly replace the function of heart and lungs , support patients with cardiac arrest due to kinds of causes .This temporary support can maintain adequate tissue perfusion and help the patients get through the dangerous stage and improve prognosis. Philips et al. firstly reported the application of PCPS. Then it was brought into clinic and developed promptly, but seldom applied in China.There are many problems limit the wide use of PCPS in clinic : the difficulty of percutaneous cannulation ; low flow volume due to smalldiameter catheter ; breakage of the red cell due to long term bypass ; the shortage of perfusion of the distal extremity and expensive cost.Therefore the aim of this experiment is to investigate how to establish PCPS which is prompt, effective ,convenient and economic ; To definite the therapeutic effect ; To do the groundwork for the clinical application in future.Material and Methods: A sterile airtight system , invented by Li Hailin , which consists of percutaneously inserted tubes for CPB, bubble oxygenator ,arterial colander, pump tubes ,prime solution and popelines. Fifteen dogs were randomly separated into three groups named A , B and C ,and each group contained 5 dogs. The dogs in A group had heart beat and were treated with percutaneously puncture; The B group had no heart beat and was treated with percutaneously puncture; The C group also had no heart beat and was treated with intubation by cut open. Tracher incision and intubation was inserted after abdomen anesthesia. Two 7F tubes were inserted into right femora artery and vein, and femoral artery pressure and central vein pressure were continuously measured by monitor attached with them. 3mg/kg heparin was injected and ACT >400s.In group A, after the tube was inserted into left femoral artery and vein ,the dogs were suffocated and 8 minutes later ECPB started .In group B, normal CPR and ECPB with blindly puncture in leftartery and vein were started after cardiac arrest exceeded 8 minutes with suffocation.In group C, normal CPR and ECPB with incision of the left artery and vein were started after cardiac arrest exceeded 8 minutes with suffocation.The electrocardiogram, ABP, CVP, SPO₂ were monitored continuously before and during ECPB. The artery and venous gas analysis were recorded per 0.5 hour with ABL510. The formation time of the ECPB, volume of flow , leakage amount of the wound, ROSC(QRS wave and pulsation of the great artery existed more than 1 hour) were recorded.The flow rate of ECPB 50～100ml/kg. The machine stopped after 60 min pumping or ROSC recovered.Results: The formation of ECPB was successful in three groups . The formation time in group A and B was significantly shorter than that in group C (P<0.05) ; The leakage amount in group A and B was significantly fewer than that in group C (P<0.01) ; There were no significant differences among three groups in Arterial flow , MAP, CVP; There were significantly differences of PCO2 and PO₂ before and after bypass; There were no significant differences in changes of hemodynamic and arterial blood gas among three groups; The ROSC in group A and B was improved significantly than that in group C.Conclusion: The formation of ECPB can be rapidly reached throughpercutaneous puncturing peripheral blood vessel and the ROSC of CPR was remarkably improved on animals.