Delayed hyperenhancement obtained by non-contrast computed tomography following coronary angiography in patients of extracorporeal cardiopulmonary resuscitation

Abstract

Abstract Background/Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to improve survival and neurologic outcome as compared to conventional CPR in refractory cardiac arrest. Although prognostic factors of these patients have been reported, predicting of outcome is difficult in real world. Recently, early evaluation of myocardial viability in acute myocardial infarction by non-contrast computed tomography (CT) post coronary angiography (CAG) has been reported. And myocardial contrast delayed enhancement obtained by this method related to higher risk of cardiac events. However, few studies have reported delayed enhancement on left ventricular wall findings in non-contrast CT after CAG in terms of patients performed ECPR. Purpose To investigate the impact of delayed hyperenhancement obtained by non-contrast CT following CAG in patients performed ECPR. Methods We investigated 79 patients treated by ECPR for refractory cardiac arrest regardless of whether in-hospital or out-hospital in our institute from Apr 2009 to Feb 2018. Thirty-two in these patients received non-contrast CT following CAG with ECPR were enrolled. All ECPR cases underwent VA-ECMO in the catheter laboratory using percutaneous procedure while maintaining conventional CPR. Non-ECG-gated and non-contrast CT was performed using a 64-row multidetector CT scanner. Results Survival rate was 18.8% in this cohort. There was no significant difference between survive and in-hospital death group in terms of patient characteristics, clinical time courses, initial blood samples and procedure characteristics. Only delayed hyperenhancement showed significant difference between 2 groups (p=0.04). All delayed hyperenhancements were detected in only in-hospital death group. Delayed hyperenhancement was detected in 12 cases (37.5%). Initial shockable rhythm was less common in cases with delayed hyperenhancement. Cardiac death tended to be more frequent in patients with delayed hyperenhancement. The major causes of death were bleeding (41.7%) and heart failure (33%). Conclusion(s) Delayed hyperenhancement in patients treated ECPR was strong predictor of in-hospital death. Image of delayed hyperenhancement Funding Acknowledgement Type of funding source: None