Abstract 301: A Systematic Diagnostic and Therapeutic Approach for the Treatment of Patients After Cardiopulmonary Resuscitation: A Prospective Evaluation of 212 Patients During 5 Years
Background: There is a need for a systematic treatment protocol for patients after resuscitation.
Methods: A systematic diagnostic approach including ECG, echocardiogram, urgent cardiac catheterization (“STEMI-like” workflow), pulmonary angiography, CT scans, pre-defined laboratory findings, IABP, hypothermia and cMRI prospectively during the last 5 years was in our cardiology department evaluated. The primary endpoint was the Cerebral Perfomance Category Scale (CPCS).
Results: From January 2008 to December 2012, 212 patients were included into our protocol. Mean age was 66.7 years, 71.2 % were male, the mean ejection fraction was 42.9 %, the mean time from first medical contact to start of catheterization/intervention was 76.6 minutes. Ventricular fibrillation (VF) was observed in 99 patients reflecting 46.7 %.
A significant coronary artery stenosis (defined as % stenosis > 60 %) was found in n=130 (61.3 %) and a percutaneous coronary intervention (PCI) was performed in 101 patients (47.6 %). An acute coronary syndrome (ACS) was diagnosed in 100 patients (47.2 %), 91 patients (42.9 %) had a cardiomyopathy, and 7 patients (3.3 %) had evidence for a Tako-Tsubo cardiomyopathy.
Rare diagnoses were patients with pulmonary embolism (n=8, 3.8 %), a long QT syndrome (n= 4, 1.9 %), an early repolarization syndrome (n= 2, 0.9 %), hypertrophic cardiomyopathy (n= 1, 0.5 %) and aortic dissection (n=1, 0.5 %).
A mechanical recanalization of a large thrombus of the pulmonary artery was performed in one patient.
An extracardiac cause for cardiac arrest was observed in 12 patients (5.7 %) and mostly secondary to stroke (cerebral infarction/bleeding).
Results: endpoints The survival rate was n=76 (35.9 %), a CPCS of 1/2 was established in 67 patients (31.8 %).
In patients being treated with a PCI, a significant difference in mortality was found for patients with TIMI flow 2/3 vs 0/1 (65.4 % vs. 95.7, p< 0.05). The difference in mortality with respect to intra-aortic balloon pumping vs. no pumping was not statistically significant (70.0 % vs. 63.6 %, p=0.6). Hypothermia was able to reduce mortality significantly (52.7 % vs 68.2 %, p<0.05).
Conclusion: A systematic diagnostic and therapeutic algorithm using a “STEMI-like” workflow is feasible, safe and can improve prognosis.
Author Disclosures: H. von Korn: None. V. Stefan: None. R. van Ewijk: None. K. Chakraborty: None. J. Hemker: None. U. Hink: None. M. Ohlow: None. B. Lauer: None. D. Vagts: None. T. Münzel: None.
- © 2014 by American Heart Association, Inc.