Revascularization During Cardiac Arrest with Extracorporeal Life Support in Heart Attack Patients
Author Information
Author(s): Nakashima Takahiro MD, PhD, Arai Marina MD, Inoue Akihiko MD, Hifumi Toru MD, Sakamoto Tetsuya MD, Kuroda Yasuhiro MD, Tahara Yoshio MD
Primary Institution: University of Michigan, Ann Arbor, Michigan, USA
Hypothesis
What are the characteristics and outcomes of patients with out-of-hospital cardiac arrest due to acute myocardial infarction who undergo primary PCI during refractory cardiac arrest despite ECPR?
Conclusion
One-third of patients with acute myocardial infarction and refractory out-of-hospital cardiac arrest treated with extracorporeal life support did not achieve sustained return of spontaneous circulation prior to primary PCI, but two-thirds achieved it following reperfusion, and one-fifth survived to discharge.
Supporting Evidence
- Among 671 patients, 251 had refractory cardiac arrest despite ECPR initiation.
- Following coronary reperfusion, 64.9% achieved sustained return of spontaneous circulation.
- 21.1% of patients survived to hospital discharge.
- 10.4% had favorable neurological status at discharge.
- Intermittent prehospital ROSC was significantly associated with survival.
Takeaway
In heart attack patients who had a cardiac arrest and didn't get their heart beating again before a procedure, many were able to get their heart beating again after the procedure, and some even survived.
Methodology
This study analyzed data from a multicenter ECPR registry in Japan, focusing on patients with acute myocardial infarction and out-of-hospital cardiac arrest who underwent primary PCI with ECPR from 2013 to 2018.
Potential Biases
Potential selection bias related to treatment quality due to the non-randomized nature of the study.
Limitations
The study was not a randomized controlled trial, which may introduce selection bias, and it lacked detailed information on devices used or door-to-balloon time for primary PCI.
Participant Demographics
Patients aged 18 years and older with acute myocardial infarction and out-of-hospital cardiac arrest.
Statistical Information
P-Value
p<0.001
Confidence Interval
95% CI: 16.9%-27.6%
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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