Should We Emergently Revascularize Occluded Coronaries for Cardiac Arrest?: Rapid-Response Extracorporeal Membrane Oxygenation and Intra-Arrest Percutaneous Coronary Intervention
Background—Extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI) may be useful in cardiopulmonary resuscitation (CPR). However, little is known about the combination of ECMO and intra-arrest PCI. This study investigated the efficacy of rapid-response ECMO and intra-arrest PCI in cardiac arrest patients who were unresponsive to conventional CPR complicated with acute coronary syndrome (ACS).
Methods and Results—This multicentre cohort study was conducted using the database of ECMO in Hiroshima City. Between January 2004 and May 2011, rapid-response ECMO was performed in 86 patients with ACS who were unresponsive to conventional CPR. The median age of the study patients was 63 years old, and 81% were male. Emergency coronary angiography was performed in 81 patients (94%) and intra-arrest PCI was performed in 61 patients (71%). The rates of return of spontaneous heart-beat, 30-day survival, and favourable neurological outcomes were 88%, 29%, and 24%, respectively. All of the patients who received intra-arrest PCI achieved return of spontaneous heart-beat. In patients who survived up to day 30, the rate of out-of-hospital cardiac arrest was lower (58% vs. 28%, P = 0.01), the intra-arrest PCI was higher (88% vs. 70%, P = 0.04), and the time interval from collapse to the initiation of ECMO was shorter (40 min [25-51 min] vs. 54 min [34-74 min], P = 0.002).
Conclusions—Rapid-response ECMO plus intra-arrest PCI is feasible and associated with improved outcomes in patients who are unresponsive to conventional CPR. Based on these findings, randomized studies of intra-arrest PCI are needed.
- acute coronary syndrome
- cardiac arrest
- cardiopulmonary bypass
- cardiopulmonary resuscitation
- extracorporeal membrane oxygenation
- Received September 11, 2011.
- Accepted August 3, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited