Abstract 269: Comparison Of Coronary Anatomy And Percutaneous Coronary Intervention Between Patients Undergoing Conventional And Extracorporeal Membrane Oxygenation Resuscitation

Abstract

Introduction: Because reestablishment of spontaneous circulation (ROSC) is frequently not achieved by conventional cardiopulmonary resuscitation (C-CPR), selected patients undergo resuscitation with extracorporeal membrane oxygenation (E-CPR). If coronary cause is suspected, coronary angiography (CAG) and percutaneous coronary intervention (PCI) are performed. Hypothesis: Coronary anatomy in E-CPR patients is more complex. Despite decreased and retrograde aortic blood flow, PCI is feasible and successful. Methods: Forty-three consecutive E-CPR patients undergoing immediate CAG admitted between August 2013 to May 2022 were matched by sex and age with 43 patients with ROSC after C-CPR. Results: Except for increased body mass index (28.9 ± 4.6 vs 26.3 ± 2.7; p=0.002) and more smoking (79% vs 58%; p=0.021) in E-CPR group , there was no significant differences in patient characteristics. Arrest was witnessed in 100% in E-CPR and 93% in C-CPR (p=0.078), basic life support was performed in 100% and 84% (p=0.006) and initial shockable rhythm was present in 63% and 82% (p=0.054), respectively. Multivessel disease (60.4% vs 32.5%) and chronic total occlusion (27.9% vs 9.3%) were more prevalent in E-CPR group (Table). There was no difference in the incidence and distribution of the acute culprit lesion present in >90%. Syntax score was significantly increased in E-CPR group. E-CPR patients received more stents (2.08 vs 1.38/patient) with increased total length (49.3 vs 27.7 mm). There was no significant difference in final TIMI 3 (88.9% vs 97.4%). Residual Syntax score remained increased in E-CPR group. Conclusion E-CPR patients have more extensive chronic coronary disease without significant difference in acute culprit lesion. More complex anatomy may be, in the setting of comparable initial resuscitation, responsible for C-CPR failure. PCI in E-CPR is successful but more complex with increased residual disease burden.