Abstract 110: Importance of Mechanical Circulatory Support and Immediate Reperfusion of Occluded Coronary Artery in Patients with Acute Coronary Syndrome and Metabolic Phase of Ventricular Fibrillation
Spontaneous circulation can not be obtained only by electrical shocks when ventricular fibrillation (VF) persisted for >10 minutes. This is referred as a metabolic phase, but the effective treatment during this phase has not been established. In the year of 2005, we had two male patients with acute coronary syndrome (ACS) and with incessant VF refractory to shocks >three times. They were treated with extracorporeal circulation (percutaneous cardiopulmonary support (PCPS) and intra-aortic balloon pumping) and reperfusion of occluded coronary artery with percutaneous coronary intervention (PCI), and both of them recovered without any brain damage. Subsequently, we used the same therapeutic strategy in 8 patients with ACS and cardiac arrest (7 men and 1 woman, mean age 66 years old, ranging from 47 to 82). Two patients had pulseless electrical activity (PEA), one asystole, and the other 5 incessant VF refractory to multiple shocks. In 5 of the 8 patients (63%), spontaneous circulation returned after reperfusion by PCI. All 5 patients had incessant VF. The other 3 patients died within 48 hours, one of whom had asystole due to left main trunk occlusion, and the remaining 2 PEA due to occlusion of three coronary arteries or coronary occlusion caused by ascending aortic dissection. All of the 5 recovered patients were treated with hypothermia for 48 hours after reperfusion, and successfully released from the mechanical and medical circulatory support. One of the 5 patients had his right leg amputated because of necrosis caused by canulation of PCPS. Four of the 5 patients (50% of all patients with cardiac arrest) were discharged from the hospital without any neurological deficits. The longest period from the cardiac arrest to full neurological recovery was 45 days. The 5 patients with spontaneous circulation recovery were suggested to be in the metabolic phase of VF, and immediate extracorporeal support and direct approach to the cause of VF were considered to be a key for return of spontaneous circulation. Effective and continuous chest compressions and extracorporeal circulation followed by hypothermia would be important for neurological recovery.