Cardiac Arrest and The Use of Mechanical Compression Devices in Patients Presenting for Primary Percutaneous Coronary Intervention

Abstract

Background: Cardiac arrest has been associated with poor outcomes in patients presenting for primary percutaneous coronary intervention (PPCI). Mechanical compression devices such as the Lund University Cardiopulmonary Assist System (LUCAS-3) aim to reduce ischaemic time during cardiopulmonary resuscitation. Methods: We conducted a retrospective review of consecutive patients with ST-elevation myocardial infarction or suspected severe myocardial ischaemia undergoing PPCI at a large tertiary institution between January 2017–December 2018. The study group comprised patients with an out-of-hospital cardiac arrest (OOHCA), in-hospital cardiac arrest (IHCA), or both. Demographic data, downtime (defined as the time from recognised arrest to return of spontaneous circulation (ROSC)), use of the LUCAS-3, and survival to discharge, were collected. Results: Of 630 patients, 80 (12.7%) were identified as either OOHCA, IHCA, or both; of whom 75 (93.4%) achieved ROSC prior to attempt at PPCI. 7 patients had an on-table IHCA during angiography without obtaining ROSC. 55 patients (68.8%) were discharged alive. Comparison of baseline demographics between survival to discharge and fatality: Age: 59.8 vs 65.7 years (p = 0.018), median downtime 4 vs 32 minutes (p < 0.001), gender was not significant (p = 0.32). ROSC was achieved in all vs 52% (p < 0.001) respectively. LUCAS-3 was used in 16 patients, of whom 3 were discharged alive and had achieved ROSC prior to attempt at PPCI. Conclusions: Younger age, shorter downtime, and ROSC predict survival to discharge in patients with OOHCA, IHCA, or both who present for PPCI. LUCAS-3 did not show utility in our cohort in the absence of ROSC prior to PPCI.