Abstract 32: Cardiac Arrest: Who Goes to the Catheterization Lab?

Abstract

Introduction: Therapeutic hypothermia (TH) is neuroprotective and increases survival in resuscitated cardiac arrest patients. Approximately 70% of sudden cardiac deaths are caused by coronary heart disease. For patients requiring angiography/PCI, TH can occur simultaneously. Methods: “Cool It” is a comprehensive TH protocol integrated into a regional STEMI network. From Feb 2006 to July 2010, 192 consecutive cardiac arrest patients who remained unresponsive following return of spontaneous circulation were enrolled in the Cool It protocol. Those patients with suspicion for ischemic etiology or evidence of STEMI were transferred directly to the cath lab. Results: On the 192 patients, angiogram was performed in 144 (75.0%). Patients sent for angiography had higher prevalence of initial rhythm VF/VT 116 (80.6%) vs. 19 (39.6%), cardiogenic shock 66 (45.8%) vs. 11 (22.9%), and ST elevation 54 (37.5%) vs. 1 (2.1%) than the 48 patients not undergoing angiography. PCI was performed in 73 (50.7% of patients undergoing angiogram, 38.0% all patients). Of these 73 patients, 64 (87.7%) had initial rhythm VF/VT, 38 (52.1%) were in cardiogenic shock, and 39 (53.4%) had ST elevation. Identified culprit arteries were LAD n=30 (41.1%), RCA n=24 (32.9%), CMX n=12 (16.4%), left main n=4 (5.5%), and none n=3 (4.1%). Mean pre-PCI TIMI flow was 1.36, and post-PCI TIMI flow was 2.91. BMS was used in 31 (42.5%), DES in 40 (54.8%), and one had balloon angioplasty only. Three were referred for CABG. Survival to hospital discharge was 43/73 (58.9%), and survival with favorable neurologic outcome (cerebral performance category 1 or 2) was 39/73 (53.4%). Patients who underwent angiography but did not receive PCI had the similar outcomes: survival was 46/71 (64.8%) and favorable neurologic outcome was seen in 44/71 (62.0%). Patients who did not undergo angiography had the poorest outcome: survival was 11/48 (22.9%) and with favorable neurologic outcome was seen in 9/48 (18.8%). Conclusion: The majority of unresponsive cardiac arrest survivors underwent angiography. Patients who underwent angiography with PCI had the similar outcomes to those with angiography alone. Favorable baseline patient characteristics appear to account for the improved outcomes in the angiography group.