Abstract 310: Evaluation of the Appropriate Timing for Inducing Therapeutic Hypothermia with Extracorporeal Membrane Oxygenation for Out-of-Hospital Cardiac Arrest in Acute Coronary Syndrome
Purpose: Mild therapeutic hypothermia has been integrated into management strategies for improving the neurological outcome of cardiac arrest for out of hospital cardiac arrest. On the other hand, acute coronary syndrome (ACS) cases should be treated as earlier. We have the dilemma between two procedures when we face any cases of post cardiac arrest syndrome (PCAS). We reported rapid and safe hypothermia induction with Less Invasive Cardiopulmonary bypass Hypothermia (LICH) before. This study aimed to evaluate an appropriate timing to induce LICH ‘before or after’ investigations for coronary angiography (CAG).
Methods: Sixteen PCAS patients for ACS were treated with LICH. These patients were divided into before CAG (Group B, N=12) and after CAG (Group A, N=4) groups. The LICH procedure was indicated for unconscious ROSC patients under 75 years of age, and excluded with brain hemorrhage, traumatic cardiac arrest, and any risk of bleeding. Target temperature was set at 34 to 35°C for 36 to 48 hours. The specifications LICH procedure were quickly induced hypothermia via narrow pediatric cannulas on low-perfusion (1 l/min) artery-venous extra corporeal membranous oxygenation with minimal anticoagulation. Any complications, time to target temperature, temperature stability, cytokines and neurological outcomes were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2.
Results: There were no significant characteristic differences except the time to target temperature (69min vs. 161min, p<0.01) between group B and A. Any complications and favorable outcomes were no significant differences in both groups.
Conclusions: We suggest that we can choice both way early and late induction for hypothermia with LICH. These results mean an early coronary reperfusion is acceptable because of the advantages of quick induction to the target temperature.
- © 2012 by American Heart Association, Inc.