Comatose Out-of-hospital Cardiac Arrest Research Articles

Abstract 358: Coronary Features in Different Subsets of Out-of-Hospital Cardiac Arrest

Introduction: Coronary artery disease (CAD) is the leading cause of out-of-hospital cardiac arrest (OHCA) which is usually triggered by acute coronary event. Hypothesis: CAD is more complex if acute coronary event is associated with OHCA. CAD complexity progressively increases from patients with reestablishment of spontaneous circulation (ROSC) to patients with refractory OHCA. Aims: To investigate CAD features in different subgroups of OHCA and compare them to patients with acute coronary syndrome without OHCA. Methods: Consecutive conscious and comatose OHCA with ST-elevation myocardial infarction (STEMI) after ROSC and patients with refractory OHCA undergoing veno-arterial extracorporeal membrane oxygenation (E-CPR OHCA) were compared to STEMI without OHCA (STEMI no OHCA). Results: Between 2016 and 2022, 71 conscious OHCA, 157 comatose OHCA, 50 E-CPR OHCA and 101 randomly selected STEMI no OHCA underwent immediate coronary angiography. Acute culprit lesion was documented less often in OHCA subsets (88.1% vs 97%; p=0.009) but complete occlusion was more prevalent (68.8% vs 58.4%; p=0.038) (Figure A) . Incidence of multivessel disease, > 50% unprotected left main stenosis, and presence of > 1 chronic total occlusion progressively increased from STEMI no OHCA to E-CPR OHCA. This was reflected in baseline SYNTAX score which was 5.6 in STEMI no OHCA,10.2 in conscious OHCA, 13.4 in comatose OHCA and 26.8 in E-CPR OHCA (p<0.001) (Figure B) . There was a linear correlation between SYNTAX score and delay to ROSC (r 2 =0.61; p<0.001) (Figure C) . Baseline and residual SYNTAX scores were among independent predictors of 5-year survival which was significantly decreased in comatose (56.1%) and E-CPR (36.0%) OHCA (Figure D) . Conclusion: OHCA is associated with increased incidence of acute coronary occlusion and progressive complexity of CAD from conscious OHCA to E-CPR OHCA. Severity of CAD is associated with increased delays to ROSC and decreased long-term survival.

Coronary features across the spectrum of out-of-hospital cardiac arrest with ST-elevation myocardial infarction (CAD-OHCA study)

AimWe hypothesized that adult patients with out-of-hospital cardiac arrest (OHCA) and ST-elevation myocardial infarction (STEMI) requiring prolonged resuscitation have more severe coronary artery disease (CAD) than those responding rapidly, and more severe CAD than patients with STEMI without OHCA. MethodsConsecutive conscious and comatose OHCA patients with STEMI after reestablishment of spontaneous circulation (ROSC), and patients with refractory OHCA undergoing veno-arterial extracorporeal membrane oxygenation (E-CPR OHCA) were compared to STEMI without OHCA (STEMI no OHCA). CAD severity was assessed by a single physician blinded to the resuscitation method, time to ROSC and level of consciousness. ResultsBetween 2016 and 2022, 71 conscious OHCA, 157 comatose OHCA, 50 E-CPR OHCA and 101 STEMI no OHCA underwent immediate coronary angiography. Acute culprit lesion was documented less often in OHCA (88.1% vs 97%; p = 0.009) but complete occlusion was more frequent (68.8% vs 58.4%; p = 0.038) than in STEMI no OHCA. SYNTAX score was 5.6 in STEMI no OHCA, 10.2 in conscious OHCA, 13.4 in comatose OHCA and 26.8 in E-CPR OHCA (p < 0.001). There was a linear correlation between SYNTAX score and delay to ROSC/ECMO initiation (r2 = 0.61; p < 0.001). Post PCI culprit TIMI 3 flow was comparable between the groups (≥86%). SYNTAX score was among independent predictors of 5-year survival which was significantly decreased in comatose OHCA (56.1%) and E-CPR OHCA (36.0%) compared to conscious OHCA (83.1%) and STEMI no OHCA (88.1%). ConclusionCompared to STEMI no OHCA, OHCA was associated with increased incidence of acute coronary occlusion and more complex non culprit CAD which progressively increased from conscious OHCA to E-CPR OHCA. Severity of CAD was associated with increased delays to ROSC/ECMO initiation and decreased long term survival.

Echocardiographic parameters during prolonged targeted temperature Management in out-of-hospital Cardiac Arrest Survivors to predict neurological outcome \u2013 a post-hoc analysis of the TTH48 trial

BackgroundTransthoracic echocardiographic (TTE) indices of myocardial function among survivors of out-of-hospital cardiac arrest (OHCA) have been related to neurological outcome; however, results are inconsistent. We hypothesized that changes in average peak systolic mitral annular velocity (s’) from 24 h (h) to 72 h following start of targeted temperature management (TTM) predict six-month neurological outcome in comatose OHCA survivors.MethodsWe investigated the association between peak systolic velocity of the mitral plane (s’) and six-month neurological outcome in a population of 99 patients from a randomised controlled trial comparing TTM at 33 ± 1 °C for 24 h (h) (n = 47) vs. 48 h (n = 52) following OHCA (TTH48-trial). TTE was conducted at 24 h, 48 h, and 72 h after reaching target temperature. The primary outcome was 180 days neurological outcome assessed by Cerebral Performance Category score (CPC180) and the primary TTE outcome measure was s’. Secondary outcome measures were left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), e’, E/e’ and tricuspid annular plane systolic excursion (TAPSE).ResultsAcross all three scan time points s’ was not associated with neurological outcome (ORs: 24 h: 1.0 (95%CI: 0.7–1.4, p = 0.98), 48 h: 1.13 (95%CI: 0.9–1.4, p = 0.34), 72 h: 1.04 (95%CI: 0.8–1.4, p = 0.76)). LVEF, GLS, E/e’, and TAPSE recorded on serial TTEs following OHCA were neither associated with nor did they predict CPC180. Estimated median e’ at 48 h following TTM was 5.74 cm/s (95%CI: 5.27–6.22) in patients with good outcome (CPC180 1–2) vs. 4.95 cm/s (95%CI: 4.37–5.54) in patients with poor outcome (CPC180 3–5) (p = 0.04).Conclusionss’ assessed on serial TTEs in comatose survivors of OHCA treated with TTM was not associated with CPC180. Our findings suggest that serial TTEs in the early post-resuscitation phase during TTM do not aid the prognostication of neurological outcome following OHCA.Trial registrationNCT02066753. Registered 14 February 2014 – Retrospectively registered,