Abstract P14: Reperfusion Therapy With Percutaneous Coronary Intervention During Cardiopulmonary Resuscitation is Useful for Rescuing Cardiac Arrest Patients With Acute Coronary Syndrome and Shock-Refractory Ventricular Fibrillation
It has been reported that in patients with acute coronary syndrome (ACS) and cardiac arrest, cardiac catheterization immediately after cardiopulmonary resuscitation (CPR) and subsequent hypothermic therapy increases neurologically preserved survivors. It was not established, however, whether cardiac catheterization during CPR for cardiac arrest patients is useful. From January of 2005 to March of 2009, we experienced 12 cardiac arrest patients complicating ACS (10 men and 2 women; mean age, 61 years old, ranging from 47 to 82) who had not responded to basic and advanced cardiac life support protocols. All patients were immediately transferred to cardiac catheterization laboratory while undergoing continuous chest compression and advanced airway ventilation. The heart rhythm at cardiac catheterization was shock-refractory ventricular fibrillation (VF) in 5 patients, pulseless electrical activity (PEA) in 5, and asystole (Asys) in the other 2. While preparing coronary angiography, both intra-aortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) were installed in 9 patients and IABP alone in the other 3. Primary percutaneous coronary intervention (PCI) with stenting was attempted against the culprit, occluded coronary artery in all patients. PCI resulted in successful reperfusion in 10 (83%) and did not in the other 2 (one with Stanford type A dissection and another with three vessel occlusion). Return of spontaneous circulation (ROSC) was obtained in 9 of the10 patients with successful reperfusion (5 of 5 VF patients, 3 of 5 PEA, and one of 2 Asys). ROSC was not obtained in the 2 without successful reperfusion. Five patients recovering from VF became free from circulation assisting devices and drugs after 48 hours of hypothermia, and 4 of them could discharge from hospital with 3 in a neurologically normal state. Despite ROSC, 4 patients with PEA or Asys died during hospitalization. In conclusion, reperfusion of the culprit lesion by PCI during CPR is useful for rescuing cardiac arrest patients with ACS and shock-refractory VF.