Outcomes of Cardiopulmonary Resuscitation and Predictors of Survival in Patients Undergoing Coronary Angiography Including Percutaneous Coronary Interventions (original) (raw)
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The Role of Emergency Coronary Intervention During and Following Cardiopulmonary Resuscitation
Critical Care Clinics, 2012
The vast majority of patients with out-of-hospital cardiac arrest have underlying coronary artery disease. Autopsy studies have documented an 80% to 90% incidence of significant coronary disease in adults succumbing to sudden cardiac death. 1 Prospective studies of coronary angiography of those successfully resuscitated also show an incidence of coronary disease approaching 80%. 2 Acute coronary ischemia is a common trigger for out-of-hospital ventricular fibrillation cardiac arrest. Culprit lesions can be readily identified during coronary angiography immediately after resuscitation in 90% of those with ST elevation myocardial infarction (STEMI) and in 25% of those without STEMI. 3
Circulation-cardiovascular Interventions, 2010
Background-Acute coronary occlusion is the leading cause of cardiac arrest. Because of limited data, the indications and timing of coronary angiography and angioplasty in patients with out-of-hospital cardiac arrest are controversial. Using data from the Parisian Region Out of hospital Cardiac ArresT prospective registry, we performed an analysis to assess the effect of an invasive strategy on hospital survival. Methods and Results-Between January 2003 and December 2008, 714 patients with out-of-hospital cardiac arrest were referred to a tertiary center in Paris, France. In 435 patients with no obvious extracardiac cause of arrest, an immediate coronary angiogram was performed at admission followed, if indicated, by coronary angioplasty. At least 1 significant coronary artery lesion was found in 304 (70%) patients, in 128 (96%) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation, and in 176 (58%) of 301 patients without ST-segment elevation. The hospital survival rate was 40%. Multivariable analysis showed successful coronary angioplasty to be an independent predictive factor of survival, regardless of the postresuscitation ECG pattern (odds ratio, 2.06; 95% CI, 1.16 to 3.66). Conclusions-Successful immediate coronary angioplasty is associated with improved hospital survival in patients with or without ST-segment elevation. Therefore, our findings support the use of immediate coronary angiography in patients with out-of-hospital cardiac arrest with no obvious noncardiac cause of arrest regardless of the ECG pattern. (Circ Cardiovasc Interv. 2010;3:200-207.) Key Words: cardiac arrest Ⅲ PCI Ⅲ angioplasty Ⅲ catheterization Ⅲ electrocardiography O ut-of-hospital cardiac arrest (OHCA) is a leading cause of death in western countries. Each year, Ͼ225 000 people in the United States die suddenly mostly because of coronary heart disease. 1,2 Despite recent advances in public education and resuscitation process, few patients will survive up to hospital admission and even fewer will be discharged alive from the hospital. Hospital survival rates remain low, ranging from 21% to 33%, and clearly have not improved in recent years. 3-5 Editorial see p 197 Clinical Perspective on p 207 Based on past clinical studies, recent guidelines recommend that patients resuscitated from OHCA who have elec-trocardiographic criteria for myocardial infarction with STsegment elevation should undergo immediate coronary angiography with subsequent percutaneous intervention (PCI), if indicated. However, the predictive value of the ECG for coronary artery occlusion is poor, and clinical data such as chest pain or risk factors often are lacking in the setting of OHCA. 6-8 Furthermore, given the high incidence of acute coronary syndrome (ACS) in patients with OHCA, guidelines also recommend considering immediate coronary angiography in all patients with postcardiac arrest in whom ACS is suspected. 9,10 Therefore, it is difficult in clinical practice to select candidates for early coronary angiography, especially
The American Journal of Cardiology, 2014
Outcomes in patients with out-of-hospital cardiac arrest (CA) who undergo percutaneous coronary intervention (PCI) have been limited to small, mostly single-center studies. We compared patients who underwent PCI after CA included in the CathPCI Registry with those without CA. Patients with ST elevation were classified as ST-elevation myocardial infarction (STEMI); all other patients having PCI were classified as without STEMI. Patients with CA in each group were compared with the corresponding non-CA groups for baseline characteristics, angiographic findings, and outcomes. A total of 594,734 patients underwent PCI, of whom 114,768 had STEMI, including 9,375 (8.2%) had CA, and 479,966 had without STEMI, including 2,775 (0.6%) had CA. Patients with CA were similar in age to patients with non-CA, with a lower frequency of coronary disease risk factors and known coronary disease. On angiography, patients with CA were significantly more likely to have more complex lesions with worse baseline thrombolysis in myocardial infarction flow. Patients with CA were significantly more likely to have cardiogenic shock, both for patients with STEMI (51% vs 7.2%, respectively) and for patients without STEMI (38% vs 0.8%, respectively, both p<0.001). In-hospital mortality was substantially worse in patients with CA, for both patients with STEMI (24.9% vs 3.1%, respectively) and patients without STEMI (18.7% vs 0.4%, respectively). In conclusion, patients who underwent PCI after CA had more complex anatomy, more shock, and higher mortality. The substantially increased mortality in patients with CA has important implications for the development and regionalization of centers for CA.
Circulation: …, 2010
Background-Acute coronary occlusion is the leading cause of cardiac arrest. Because of limited data, the indications and timing of coronary angiography and angioplasty in patients with out-of-hospital cardiac arrest are controversial. Using data from the Parisian Region Out of hospital Cardiac ArresT prospective registry, we performed an analysis to assess the effect of an invasive strategy on hospital survival. Methods and Results-Between January 2003 and December 2008, 714 patients with out-of-hospital cardiac arrest were referred to a tertiary center in Paris, France. In 435 patients with no obvious extracardiac cause of arrest, an immediate coronary angiogram was performed at admission followed, if indicated, by coronary angioplasty. At least 1 significant coronary artery lesion was found in 304 (70%) patients, in 128 (96%) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation, and in 176 (58%) of 301 patients without ST-segment elevation. The hospital survival rate was 40%. Multivariable analysis showed successful coronary angioplasty to be an independent predictive factor of survival, regardless of the postresuscitation ECG pattern (odds ratio, 2.06; 95% CI, 1.16 to 3.66). Conclusions-Successful immediate coronary angioplasty is associated with improved hospital survival in patients with or without ST-segment elevation. Therefore, our findings support the use of immediate coronary angiography in patients with out-of-hospital cardiac arrest with no obvious noncardiac cause of arrest regardless of the ECG pattern. (Circ Cardiovasc Interv. 2010;3:200-207.) Key Words: cardiac arrest Ⅲ PCI Ⅲ angioplasty Ⅲ catheterization Ⅲ electrocardiography O ut-of-hospital cardiac arrest (OHCA) is a leading cause of death in western countries. Each year, Ͼ225 000 people in the United States die suddenly mostly because of coronary heart disease. 1,2 Despite recent advances in public education and resuscitation process, few patients will survive up to hospital admission and even fewer will be discharged alive from the hospital. Hospital survival rates remain low, ranging from 21% to 33%, and clearly have not improved in recent years. 3-5 Editorial see p 197 Clinical Perspective on p 207 Based on past clinical studies, recent guidelines recommend that patients resuscitated from OHCA who have elec-trocardiographic criteria for myocardial infarction with STsegment elevation should undergo immediate coronary angiography with subsequent percutaneous intervention (PCI), if indicated. However, the predictive value of the ECG for coronary artery occlusion is poor, and clinical data such as chest pain or risk factors often are lacking in the setting of OHCA. 6-8 Furthermore, given the high incidence of acute coronary syndrome (ACS) in patients with OHCA, guidelines also recommend considering immediate coronary angiography in all patients with postcardiac arrest in whom ACS is suspected. 9,10 Therefore, it is difficult in clinical practice to select candidates for early coronary angiography, especially
The American Journal of Emergency Medicine, 2013
Special attention to post-cardiac arrest management is important to long-term survival and favorable neurological outcome in patients resuscitated from cardiac arrest. The use of emergent percutaneous coronary intervention in resuscitated patients presenting with ST-segment elevation myocardial infarction has long been considered an appropriate approach for coronary revascularization. Recent evidence suggests that other subsets of patients, namely, post-cardiac arrest patients without ST-segment elevation myocardial infarction, may benefit from immediate percutaneous coronary intervention following resuscitation. These findings could eventually have important implications for the care of resuscitated patients, including transportation of resuscitated patients to appropriate cardiac interventional facilities, access to treatment modalities such as therapeutic hypothermia, and coordinated care with cardiac catheterization laboratories.
European Heart Journal, 2013
Purpose: Coronary angiogram (CA) with percutaneous coronary intervention (PCI) on admission may improve survival to hospital discharge in patients resuscitated from an out-of-hospital cardiac arrest (OHCA), but data on the long-term survival are rare. The purpose of our study was to assess long-term survival in OHCA patients managed with CA on admission and PCI if indicated and to compare survival between patients with and without acute myocardial infarction (AMI). Methods: Retrospective single-centre study including patients ≥18 years old resuscitated from an OHCA without obvious non-cardiac cause undergoing CA on admission with PCI if indicated. AMI was diagnosed angiographically as presence of lesions suggestive of ruptured plaques with critical stenosis and presence of thrombus easily crossed by an angioplasty wire. Survival was recorded at hospital discharge and at 5-years follow-up and probability of survival was estimated by Kaplan-Meier survival curves. Data are expressed as numbers (percentages) and median (interquartile range-IQR). Results: 300 comatose patients aged 56 (48-67) were included between 2002 and 2011. 130 patients (43%) had ventricular fibrillation, 116 (39%) asystole, 6 (2%) ventricular tachycardia, 18 (6%) pulseless electrical activity and 30 (10%) had unknown initial rhythm. All patients had CA on hospital admission and 93 (31%) had angiographically defined AMI. PCI was attempted in 85 (91%) of the patients with AMI, successful in 79 (93%) of the attempts. Therapeutic hypothermia was performed in 256 (84%) of the patients. Survival at hospital discharge was 32.3% (97 survivors). After hospital discharge, 5-year overall probability of survival was 81.7±5.4%. Probability of survival from admission to 5-year follow-up was 26.2% ± 2.8%. Patients with AMI had better survival at hospital discharge, 40.8% (38 survivors) than non-AMI patients, 28.5% (59 survivors), p=0.047. There was a tendency for better post-discharge probability of survival at 5-years follow-up in AMI patients, 92.2% ± 5.4% versus 73.4±8.6% in non-AMI patients, hazard ratio (HR) = 2.7, confidence interval (CI) = (0.8-8.9), p=0.1. Probability of survival from admission to 5-years follow-up was better for AMI patients, 37.4% ± 5.2% than for non-AMI patients, 20.7% ± 3.0%, HR = 1.5, CI = (1.12-2.0), p=0.0067. Conclusion: We observed a very favourable post-discharge prognosis in OHCA patients undergoing on-admission CA with PCI if indicated. In this study, patients suffering OHCA due to AMI had better survival to hospital discharge and at 5 years follow-up than patients suffering OHCA due to other causes.
Cureus, 2019
Coronary artery disease (CAD) is the most common killer disease, responsible for about onethird of all deaths at ages above 35. The majority of all survivors of out-of-hospital cardiac arrests present to the emergency department (ED) with an initial shockable rhythm (ventricular fibrillation or pulse-less ventricular tachycardia), which is a predictor of survival. Odds for survival are less for non-shockable rhythm and favorable neurologic outcomes decrease as the length of cardiopulmonary resuscitation (CPR) increases. The median time-to-return of spontaneous circulation among those with favorable neurological outcomes is less than 10 minutes. On the other hand, a large review of more than 64,000 patients with in-hospital cardiac arrests showed that patients with longer median resuscitation times had a greater chance of the return of spontaneous circulation and survival to discharge. We described a case of prolonged resuscitation lasting almost three hours of CPR followed by successful percutaneous intervention with a favorable neurologic outcome.
Catheterization and Cardiovascular Diagnosis, 1990
Cardiac arrest in the catheterization laboratory is fatal if unresponsive to advanced cardiac life support (ACLS). Seven patients not responding to ACLS following cardiac arrest in the catheterization laboratory undarwent percutaneously instituted cardiopulmonary bypass support. Cardiac arrest occurred following abrupt closure postcoronary angioplasty in three patients, during cardiogenic shock in three patients, and during diagnostic angiography in one patient. Cardiopulmonary bypass was instituted 10-45 min (mean, 21 min) following the onset of cardiac arrest. Flows on bypass ranged from 4.0 to 5.2 liter/ min. Mean blood pressure ranged from 70 to 110 mm Hg on bypass. Six of the seven patients regained consciousness after the institution of bypass. Acid-base balance was normalized in all patients. Coronary bypass surgery was subsequently performed in three patients and coronary angioplasty in two. Four patients survived. One patient died following coronary bypass surgery. Two patients, who were not suitable candidates for revascularization, expired. Total bypass time was 1.5-8.5 hr (mean, 2.7 hr). At a mean follow-up of 6 months, all four survivors are alive and asymptomatic or NYHA class 1. We conclude that cardiopulmonary bypass support 1) can stabilize patients following cardiac arrest in the catheterization laboratory, 2) can facilitate emergency coronary angioplasty or transfer to the operating room for coronary bypass surgery, and (3) can improve survival in patients unresponsive to ACLS when instituted early following cardiac arrest in the catheterization laboratory.
Percutaneous Coronary Intervention During Cardiac Arrest and Ongoing Chest Compressions
Interventional Cardiology Review, 2011
Prolonged cardiac arrest in the cath lab is associated with very high mortality rates. Use of manual chest compressions have, until recently, been the only rapid response available to circulate the patient in such scenarios. The recent introduction of mechanical chest compression devices offers a new alternative that may perform better than manual chest compressions, especially during a continued interventional procedure.