Abstract 14412: Clinical Characteristics of Patients with Out-of-Hospital Cardiac Arrest Caused by Ventricular Fibrillation Due to Acute Coronary Syndromes who Responded to Multidisciplinary Therapy
Background: Extracorporeal cardiopulmonary resuscitation (ECRP), percutaneous coronary intervention (PCI), intra-aortic balloon pumping (IABP), and therapeutic hypothermia (TH) have been reported to be effective in patients with ventricular fibrillation (VF) caused by acute coronary syndromes (ACS). However, the effectiveness of combining these treatments and the clinical characteristics of patients who best respond to combination therapy remain unclear.
Methods: This multicenter, retrospective, collaborative study was conducted in 5 hospitals. From September 2008 through September 2011, a total of 130 patients with out-of-hospital cardiac arrest aged 20 to 74 years had an initial rhythm of VF and arrived at the hospital within 45 minutes after the onset of cardiac arrest. They did not respond to standard advanced cardiac life support given for more than 15 minutes after hospital arrival and received combination therapy with ECPR, PCI, IABP, and TH. ACS was diagnosed on emergency coronary angiography in 76 patients. These patients were classified according to whether neurologic outcomes at 6 months were good (cerebral performance category, CPC=1) or poor (CPC=2-5). Demographic characteristics and coronary angiographic findings were compared between the groups.
Results: Among the 76 patients given combination therapy, 7 (9%) had good neurologic outcomes at 6 months. The following variables differed significantly between the good outcome group and poor outcome group: time from cardiac arrest to hospital arrival (25.3 ± 4.5 vs. 33.5 ± 7.5 min, p<0.01), coronary vasospasm (29% vs. 4%, p=0.01), multivessel disease (14% vs. 68%, p<0.01), and time from hospital arrival to TIMI flow grade 2 or 3 (72.0 ± 9.9 vs. 127.8 ± 13.3 min, p=0.04). Multivariate analysis showed that the interval from hospital arrival to coronary reperfusion contributed most to good neurologic outcomes at 6 months (p=0.01).
Conclusions: Patients who respond best to combination therapy with ECPR, PCI, IABP, and TH are characterized by successful reperfusion therapy for single-vessel disease. Our results suggest that shortening the interval from symptom onset until reperfusion therapy may improve neurologic outcomes in patients with refractory VF caused by ACS.
- Extracorporeal circulation
- Percutaneous coronary intervention
- Ventricular fibrillation
- Acute coronary syndromes
- © 2012 by American Heart Association, Inc.