Abstract 16818: Early Coronary Revascularization Improves 24 Hour Survival and Neurological Function After Ischemic Cardiac Arrest. A Randomized Animal Study
Background: Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. However, no randomized data exist on whether early reperfusion improves 24h survival and neurological outcomes. We hypothesized that early reperfusion of an occluded left anterior descending (LAD) artery after ischemic cardiac arrest will improve 24-hour survival and neurological outcome.
Methods: Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5 minutes, ventricular fibrillation (VF) was induced and left untreated for 8 minutes. If return of spontaneous circulation (ROSC) was achieved within 15 minutes (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45 minutes (group A) or 4 hours (group B) of LAD occlusion. Animals without ROSC after 15 minutes of CPR were classified as refractory VF (group C). In those pigs (6 total), CPR was continued up to 45 minutes of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC was achieved or another 10 minutes of CPR have been performed. Primary endpoints for groups A and B were 24-hour survival, cerebral performance category (CPC), biomarkers and Left Ventricular Ejection Faction (LVEF). Primary endpoint for group C was ROSC before or after reperfusion.
Results: Early reperfusion significantly improved outcomes: survival in group A versus B (10/11 versus 4/10, p= 0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p= 0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0.005) and CK-MB (11±4 versus 20.1±5, p=0.031), at 24 hours after ROSC. In group C, ROSC was achieved only in 4/6 after reperfusion.
Conclusions: Early reperfusion improved 24h survival rate, CPC score and decreased cardiac biomarkers of injury in an animal model of cardiac arrest caused by LAD occlusion. In animals with refractory VF, reperfusion was necessary to achieve ROSC.
- Cardiac arrest
- Cardiopulmonary resuscitation
- Ventricular fibrillation
- Acute coronary syndromes
- © 2013 by American Heart Association, Inc.