心肺停止蘇生後の重症虚血性心疾患に IMPELLA CP®，低体温療法が有効であった1例
症例は67歳の男性，仕事中に心肺停止（Cardiopulmonary arrest : CPA）となり当院に搬送された．心肺停止蘇生後，冠動脈造影検査にて3枝病変を認めた．冠血行再建の適応があると判断されたが，神経学的予後が不明のためIMPELLA CP®を留置した後に低体温療法を含めた全身管理を行った．24時間後に復温を開始し，従命可能で，四肢麻痺がないことを確認できたため準緊急でIMPELLA CP®使用下に心拍動下冠動脈バイパス術を施行した．吻合操作中，血行動態は安定していた．神経学的異常なく，術後74日後に自宅退院となった．CPA蘇生後の重症虚血性心疾患にIMPELLA CP®，低体温...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 50; no. 4; pp. 256 - 260 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.07.2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.50.256 |
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| Abstract | 症例は67歳の男性，仕事中に心肺停止（Cardiopulmonary arrest : CPA）となり当院に搬送された．心肺停止蘇生後，冠動脈造影検査にて3枝病変を認めた．冠血行再建の適応があると判断されたが，神経学的予後が不明のためIMPELLA CP®を留置した後に低体温療法を含めた全身管理を行った．24時間後に復温を開始し，従命可能で，四肢麻痺がないことを確認できたため準緊急でIMPELLA CP®使用下に心拍動下冠動脈バイパス術を施行した．吻合操作中，血行動態は安定していた．神経学的異常なく，術後74日後に自宅退院となった．CPA蘇生後の重症虚血性心疾患にIMPELLA CP®，低体温療法での加療が有効であったので報告する． |
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| AbstractList | 症例は67歳の男性，仕事中に心肺停止（Cardiopulmonary arrest : CPA）となり当院に搬送された．心肺停止蘇生後，冠動脈造影検査にて3枝病変を認めた．冠血行再建の適応があると判断されたが，神経学的予後が不明のためIMPELLA CP®を留置した後に低体温療法を含めた全身管理を行った．24時間後に復温を開始し，従命可能で，四肢麻痺がないことを確認できたため準緊急でIMPELLA CP®使用下に心拍動下冠動脈バイパス術を施行した．吻合操作中，血行動態は安定していた．神経学的異常なく，術後74日後に自宅退院となった．CPA蘇生後の重症虚血性心疾患にIMPELLA CP®，低体温療法での加療が有効であったので報告する． |
| Author | 押領司, 篤宣 庄嶋, 賢弘 高木, 数実 古野, 哲慎 朔, 浩介 高瀬, 谷徹 菊先, 聖 田山, 栄基 財満, 康之 有永, 康一 |
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| References | 6) The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Eng J Med 2002 ; 346 : 549-56. 11) Tobaru T. Revascularization in cardiogenic shock and severe CHF complicating acute myocardial infarction. J Jpn Coron Assoc 2016 ; 22 : 175-80. 13) Paolo P, Germano C, Piermario O et al. Successful use of the Impella Recover LP 5.0 device for circulatory support during off-pump coronary artery bypass grafting. Intern J Surg Case Rep 2014 ; 5 : 803-5. 8) Pieri M, Sorrentino T, Oppizzi M et al. The role of different mechanical circulatory support devices and their timing of implantation on myocardial damage and mid-term recovery in acute myocardial infarction related cardiogenic shock. J Interv Cardiol 2018 ; 31 : 717-24. 2) Lemaire A, Anderson MB, Lee LY et al. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg 2014 ; 97 : 133-8. 7) Bernard SA, Gray TW, Buist MD et al : Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Eng J Med 2002 ; 346 : 557-63. 9) O'Neill WW, Neal SK, Jefferey M et al. A prospective randomized clinical trial of hemodynamic support with impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention the PROTECT II study. Circulation 2012 ; 126 : 1717-27. 3) Nolan JP, Neumar RW, Adrie C et al. International Liaison Committee on Resuscitation ; Emergency Cardiovascular Care Committee. American Heart Association ; Council on Cardiovascular Surgery and Anesthesia ; Council on Cardiopulmonary, Perioperative, and Critical Care ; Council on Clinical Cardiology ; Council on Stroke : Postcardiac arrest syndrome : epidemiology, pathophysiology, treatment, and prognostication : a scientific statement from the International Liaison Committee on Resuscitation ; the American Heart Association Emergency Cardiovascular Care Committee ; the Council on Cardiovascular Surgery and Anesthesia ; the Council on Cardiopulmonary, Perioperative, and Critical Care ; the Council on Clinical Cardiology ; the Council on Stroke (Part II). Int Emerg Nurs 2010 ; 18 : 8-28. 5) Oto J. Review of extra corporeal membrane oxygenation (ECMO) in critically ill patients. Shikokuishi 2017 ; 73 : 207-20. 14) Niwano S, Sekiguchi Y, Ishii Y et al. Clinical usefulness of Wearable Cardioverter Defibrillator (WCD) and current understanding of its clinical indication in Japan. Circ J 2018 ; 82 : 1481-6. 4) Asaka Y, Atsumi T, Kawakami D et al. Long term prognosis after return of spontaneous circulation in sudden cardiac arrest patients. J Jpn Soc Emerg Med 2016 ; 19 : 720-4. 12) Kowalewski M, Pawliszak W, Malvindi PG et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting : meta-analysis. J Thorac Cardiovasc Surg 2016 ; 151 : 60-77. 1) Uchino H, Nagashima F, Kobayashi T et al. Cerebral protection in neuroanesthesia and neurointensive care. J Jpn Soc Clin Anesth 2017 ; 37 ; 457-74. 10) Karami M, den Uil CA, Ouweneel DM et al. Mechanical circulatory support in cardiogenic shock from acute myocardial infarction : impella CP/5.0 versus ECMO. Eur Heart J Acute Cardiovasc Care 2020 ; 9 : 164-72. |
| References_xml | – reference: 10) Karami M, den Uil CA, Ouweneel DM et al. Mechanical circulatory support in cardiogenic shock from acute myocardial infarction : impella CP/5.0 versus ECMO. Eur Heart J Acute Cardiovasc Care 2020 ; 9 : 164-72. – reference: 8) Pieri M, Sorrentino T, Oppizzi M et al. The role of different mechanical circulatory support devices and their timing of implantation on myocardial damage and mid-term recovery in acute myocardial infarction related cardiogenic shock. J Interv Cardiol 2018 ; 31 : 717-24. – reference: 11) Tobaru T. Revascularization in cardiogenic shock and severe CHF complicating acute myocardial infarction. J Jpn Coron Assoc 2016 ; 22 : 175-80. – reference: 12) Kowalewski M, Pawliszak W, Malvindi PG et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting : meta-analysis. J Thorac Cardiovasc Surg 2016 ; 151 : 60-77. – reference: 1) Uchino H, Nagashima F, Kobayashi T et al. Cerebral protection in neuroanesthesia and neurointensive care. J Jpn Soc Clin Anesth 2017 ; 37 ; 457-74. – reference: 6) The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Eng J Med 2002 ; 346 : 549-56. – reference: 4) Asaka Y, Atsumi T, Kawakami D et al. Long term prognosis after return of spontaneous circulation in sudden cardiac arrest patients. J Jpn Soc Emerg Med 2016 ; 19 : 720-4. – reference: 2) Lemaire A, Anderson MB, Lee LY et al. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg 2014 ; 97 : 133-8. – reference: 3) Nolan JP, Neumar RW, Adrie C et al. International Liaison Committee on Resuscitation ; Emergency Cardiovascular Care Committee. American Heart Association ; Council on Cardiovascular Surgery and Anesthesia ; Council on Cardiopulmonary, Perioperative, and Critical Care ; Council on Clinical Cardiology ; Council on Stroke : Postcardiac arrest syndrome : epidemiology, pathophysiology, treatment, and prognostication : a scientific statement from the International Liaison Committee on Resuscitation ; the American Heart Association Emergency Cardiovascular Care Committee ; the Council on Cardiovascular Surgery and Anesthesia ; the Council on Cardiopulmonary, Perioperative, and Critical Care ; the Council on Clinical Cardiology ; the Council on Stroke (Part II). Int Emerg Nurs 2010 ; 18 : 8-28. – reference: 7) Bernard SA, Gray TW, Buist MD et al : Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Eng J Med 2002 ; 346 : 557-63. – reference: 14) Niwano S, Sekiguchi Y, Ishii Y et al. Clinical usefulness of Wearable Cardioverter Defibrillator (WCD) and current understanding of its clinical indication in Japan. Circ J 2018 ; 82 : 1481-6. – reference: 9) O'Neill WW, Neal SK, Jefferey M et al. A prospective randomized clinical trial of hemodynamic support with impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention the PROTECT II study. Circulation 2012 ; 126 : 1717-27. – reference: 13) Paolo P, Germano C, Piermario O et al. Successful use of the Impella Recover LP 5.0 device for circulatory support during off-pump coronary artery bypass grafting. Intern J Surg Case Rep 2014 ; 5 : 803-5. – reference: 5) Oto J. Review of extra corporeal membrane oxygenation (ECMO) in critically ill patients. Shikokuishi 2017 ; 73 : 207-20. |
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| Snippet | 症例は67歳の男性，仕事中に心肺停止（Cardiopulmonary arrest : CPA）となり当院に搬送された．心肺停止蘇生後，冠動脈造影検査にて3枝病変を認めた．冠血行再建の適応があると判断されたが，神経学的予後が不明のためIMPELLA... |
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| SubjectTerms | IMPELLA OPCAB 低体温療法 心肺停止蘇生後 |
| Title | 心肺停止蘇生後の重症虚血性心疾患に IMPELLA CP®，低体温療法が有効であった1例 |
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