Abstract P94: Impact of Percutaneous Coronary Intervention and Mild Hypothermia Therapy for Patients With Out-of-hospital Cardiac Arrest of Acute Coronary Syndrome From Multicenter Hypothermia Registry in Japan
Background: Mild hypothermia (MH) had neurological benefits for patients with return of spontaneous circulation (ROSC) after ventricular fibrillation (Vf) cardiac arrest. In the majority of those patients, sudden arrest is caused by acute coronary syndrome (ACS). Percutaneous coronary intervention (PCI) was preferred treatment strategy for patients with ACS after ROSC. The purpose of this study was to evaluate favorable neurological outcomes (cerebral performance category [CPC] 1 and 2) at 30 days for unconscious patients with ROSC after out-of hospital cardiac arrest.
Method: Three years (2005–2007) data were available for the 281 patients treated with MH in the multicenter registry (12 institutions) of the J-PULSE-Hypo in Japan. Of those 122 were diagnosed as ACS by coronary angiography after ROSC (age 60+/−11, man 95% [N=116]) and were treated with MH and PCI. Intra-aortic balloon pumping (IABP) or Percutaneous cardiopulmonary assisted devices (PCPS) were used in shock state.
Result: Mean core temperature was 33.9 degrees C and mean cooling duration was 32 hours. Mean time interval from collapse to ROSC was 30min and IABP was used in 61.5% (N=75), and PCPS in 29.5% (N=36). Favorable outcome rate at 30 days was 52.3% (N=64, CPC 1=58), including 59.4% in Vf, 27.4% in Pulseless Electrical Activity and 10.0% in asystole. In multivariate analysis, age, diabetes, and time interval from collapse to ROSC were the independent predictors of 30-day favorable outcome
Conclusion: MH with PCI for patients with ROSC after out-of-hospital cardiac arrest of ACS was effective for improvement of 30 days neurologic outcome even in the case of hemodynamic unstable and in any rhythm.