Management of In-laboratory Cardiopulmonary Arrest

Abstract

The purpose of this review is to update the reader on the risk factors, causes, and mechanisms for cardiac arrest in the cardiac catheterization laboratory. In addition, the review provides a summary of recently published data specifically pertaining to the management of in-lab cardiac arrest. The incidence of cardiac arrest in unselected patients undergoing cardiac catheterization is approximately 0.5%. ST elevation myocardial infarction and cardiogenic shock account for the majority of cases. Pulseless electrical activity is the most common initial rhythm. Mechanical chest compression devices (especially if combined with a mechanical circulatory support device) can result in a high rate of return of spontaneous circulation, but survival is not different from patients receiving manual chest compressions. Case series have reported 40–60% short- and intermediate-term survival in patients treated with extracorporeal membrane oxygenation (ECMO) and correction of the underlying cause of cardiac arrest. A systematic and protocol-driven approach to the management of in-lab cardiac arrest is essential to patient survival. The rapid initiation of ECMO and comprehensive post-arrest care can result in relatively high rates of survival in selected patients.