Abstract 1765: Efficacy of Emergency Percutaneous Cardiopulmonary Support in Patients with Out-of-Hospital Cardiac Arrest by Acute Myocardial Infarction
Background: Although percutaneous cardiopulmonary support (PCPS) is a circulatory-pulmonary assistant device consisting of a centrifugal pump and a capillary membrane oxygenator, its effects on patients with out-of-hospital cardiac arrest (OHCA) remains unclear. The purpose of this study is to elucidate factors contributing to survival discharge by treatment with PCPS in patients with OHCA by acute myocardial infarction (AMI) who do not respond to standard advanced cardiovascular life support (ACLS).
Methods and Results: We retrospectively reviewed 41 AMI patients who were received PCPS for the purpose of cardiopulmonary resuscitation (CPR) and immediate coronary angiography for coronary reperfusion therapy after arrival at the hospital from 1996 to 2005. All patients in this study were witnessed their OHCA by bystanders and received bystander CPR. Eleven (27%) of 41 patients were discharged alive from the hospital. There were no differences in age (57 ± 10years vs 54 ± 13years), male sex (91% vs 90%), frequencies of ventricular fibrillation (100% vs 77%), time from OHCA to CPR start (2 ± 2minutes vs 3 ± 3minutes), time from CPR start to hospital arrival (22 ± 9minutes vs 21 ± 17minutes), time from hospital arrival to PCPS start (32 ± 17minutes vs 29 ± 13minutes) and the proportion of multivessel disease (64% vs 73%) between the survival discharge group (N = 11) and the hospital mortality group (N= 30). Time from AMI onset to OHCA was shorter (15 ± 20minutes vs 43 ± 44minutes, p < 0.05), the ratio of coronary reperfusion was higher (100% vs 53%, p < 0.01), peak CK (8300 ± 3562IU/l vs 16371 ± 12135IU/l, p < 0.05) and peak CK-MB (388 ± 298IU/l vs 943 ± 440IU/l, p < 0.01) was lower and the mean support time on the PCPS was shorter (20 ± 14hours vs 71 ± 80hours, p < 0.05) in the survival discharge group than in the hospital mortality group.
Conclusion: Although treatment with PCPS may increase survival discharge rate, it is crucial to consider time from onset to cardiac arrest and to perform coronary reperfusion therapy in case of introduction to PCPS in AMI patients with OHCA who do not respond to standard ACLS.