Abstract

BackgroundResuscitation after cardiac arrest (CA) in the catheterization laboratory (cath-lab) using mechanical chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is a strong recommendation in the 2015 European Resuscitation Council (ERC) guidelines. This study aimed at re-evaluating survival to hospital discharge and assess long term outcome in this patient population.MethodsPatients presenting at the cath lab with spontaneous circulation, suffering CA and requiring prolonged mechanical CC during cath lab procedures between 2009 and 2013 were included. Circumstances leading to CA, resuscitation parameters and outcomes were evaluated within this cohort. For comparison, patients needing prolonged manual CC in the cath lab in the pre-mechanical CC era were evaluated. Six-month and one year survival with a mechanical CC treatment strategy from 2004 to 2013 was also evaluated.ResultsThirty-two patients were included between 2009 and 2013 (24 ST-elevation myocardial infarction (STEMI), 4 non-STEMI, 2 planned PCI, 1 angiogram and 1 intra-aortic counter pulsation balloon pump insertion). Twenty were in cardiogenic shock prior to inclusion. Twenty-five were successfully treated with PCI. Median mechanical CC duration for the total cohort (n = 32) was 34 min (range 5–90), for the 15 patients with circulation discharged from the cath-lab, 15 min (range 5–90), and for the eight discharged alive from hospital, 10 min (range 5–52). Twenty-five percent survived with good neurological outcome at hospital discharge. Ten patients treated with manual CC were included with one survivor.DiscussionEighty-seven percent of the patients included in the mechanical CC cohort had their coronary or cardiac intervention performed during mechanical CC with an 80 % success rate. This shows that the use of mechanical CC during an intervention does not seem to impair the interventional result substantially. The survival rate after one year was 87 %.ConclusionsAmong patients suffering CA treated with mechanical CC in the cath-lab, 25 % had a good neurological outcome at hospital discharge compared to 10 % treated with manual CC. Long term survival in patients discharged from hospital is good.

Highlights

  • Resuscitation after cardiac arrest (CA) in the catheterization laboratory using mechanical chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is a strong recommendation in the 2015 European Resuscitation Council (ERC) guidelines

  • Among patients suffering CA treated with mechanical CC in the cath-lab, 25 % had a good neurological outcome at hospital discharge compared to 10 % treated with manual CC

  • In the patients referred for planned PCI and nonSTEMI, complications such as, for example, thrombus formation, vessel rupture and dissection caused the CA

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Summary

Introduction

Resuscitation after cardiac arrest (CA) in the catheterization laboratory (cath-lab) using mechanical chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is a strong recommendation in the 2015 European Resuscitation Council (ERC) guidelines. This study aimed at re-evaluating survival to hospital discharge and assess long term outcome in this patient population. Over the years of using mechanical CC in the cath-lab in resuscitation efforts in combination with simultaneous PCI, we have noted several practical short-comings in the work-flow. This has led to the development of a more structured and more tightly conducted approach, which has been described in detail elsewhere [11]. We continued to evaluate both short and long term outcomes in patients suffering CA treated with mechanical CC during an invasive cardiac/coronary procedure in a prospective manner between 9 April 2009 and 9 April 2013

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