Autopulse facilitated coronary angiography for out of hospital cardiac arrest

Abstract

Purpose: Out of hospital cardiac arrest (OHCA) is often caused by cardiac ischemia of which the majority present with acute coronary occlusion. The main cause of death remains central nervous system injury and myocardial failure. Optimal basic life support and early reperfusion therapy are thought to improve outcome. Basic life support can be facilitated by mechanical chest compressions. Methods: Between June 2008 and January 2012 all patients presented to the emergency room after an OHCA with suspected cardiac origin, were eligible for emergent coronary angiography. Only patients without return of spontaneous circulation (ROSC) while still on mechanical chest compression support, are presented. Results: A total of 18 patients underwent emergency coronary angiography. Percutaneous coronary intervention was attempted in 13 patients and successful in 11. Despite absence of ROSC before coronary angiography 1-day survival was 22%. Long-term survival was 17%. All survivors presented with ventricular fibrillation as initial rhythm. View this table: Table 1. Patient characteristics Conclusion: Performing coronary angiography during mechanical chest compressions for out of hospital resuscitation is feasible. Although survival remains poor, our figures suggest an improvement in survival if early revascularisation is performed. Further studies are needed to define patients that benefit from mechanical chest compressions and early coronary intervention.