Demetris Yannopoulos1, Jason A Bartos2, Ganesh Raveendran2, Marc Conterato3, Ralph J Frascone4, Alexander Trembley3, Ranjit John5, John Connett6, David G Benditt2, Keith G Lurie2, Robert F Wilson2, Tom P Aufderheide7. 1. Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota. Electronic address: yanno001@umn.edu. 2. Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota. 3. Department of Emergency Medicine, North Memorial Medical Center, Robbinsdale, Minnesota. 4. Department of Emergency Medicine, Regions Hospital, St. Paul, Minnesota. 5. Division of Cardiothoracic Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota. 6. Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota. 7. Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Abstract
BACKGROUND: The prevalence of coronary artery disease (CAD) among patients with refractory out-of-hospital (OH) ventricular fibrillation (VF)/ventricular tachycardia (VT) cardiac arrest is unknown. OBJECTIVES: The goal of this study was to describe the prevalence and complexity of CAD and report survival to hospital discharge in patients experiencing refractory VF/VT cardiac arrest treated with a novel protocol of early transport to a cardiac catheterization laboratory (CCL) for extracorporeal life support (ECLS) and revascularization. METHODS: Between December 1, 2015, and December 1, 2016, consecutive adult patients with refractory OH VF/VT cardiac arrest requiring ongoing cardiopulmonary resuscitation were transported by emergency medical services to the CCL. ECLS, coronary angiography, and percutaneous coronary intervention were performed, as appropriate. Functionally favorable survival to hospital discharge (Cerebral Performance Category 1 or 2) was determined. Outcomes in a historical comparison group were also evaluated. RESULTS: Sixty-two (86%) of 72 transported patients met emergency medical services transport criteria. Fifty-five (89%) of the 62 patients met criteria for continuing resuscitation on CCL arrival; 5 had return of spontaneous circulation, 50 received ECLS, and all 55 received coronary angiography. Forty-six (84%) of 55 patients had significant CAD, 35 (64%) of 55 had acute thrombotic lesions, and 46 (84%) of 55 had percutaneous coronary intervention with 2.7 ± 2.0 stents deployed per patient. The mean SYNTAX score was 29.4 ± 13.9. Twenty-six (42%) of 62 patients were discharged alive with Cerebral Performance Category 1 or 2 versus 26 (15.3%) of 170 in the historical comparison group (odds ratio: 4.0; 95% confidence interval: 2.08 to 7.7; p < 0.0001). CONCLUSIONS: Complex but treatable CAD was prevalent in patients with refractory OH VF/VT cardiac arrest who also met criteria for continuing resuscitation in the CCL. A systems approach using ECLS and reperfusion seemed to improve functionally favorable survival.
BACKGROUND: The prevalence of coronary artery disease (CAD) among patients with refractory out-of-hospital (OH) ventricular fibrillation (VF)/ventricular tachycardia (VT) cardiac arrest is unknown. OBJECTIVES: The goal of this study was to describe the prevalence and complexity of CAD and report survival to hospital discharge in patients experiencing refractory VF/VT cardiac arrest treated with a novel protocol of early transport to a cardiac catheterization laboratory (CCL) for extracorporeal life support (ECLS) and revascularization. METHODS: Between December 1, 2015, and December 1, 2016, consecutive adult patients with refractory OH VF/VT cardiac arrest requiring ongoing cardiopulmonary resuscitation were transported by emergency medical services to the CCL. ECLS, coronary angiography, and percutaneous coronary intervention were performed, as appropriate. Functionally favorable survival to hospital discharge (Cerebral Performance Category 1 or 2) was determined. Outcomes in a historical comparison group were also evaluated. RESULTS: Sixty-two (86%) of 72 transported patients met emergency medical services transport criteria. Fifty-five (89%) of the 62 patients met criteria for continuing resuscitation on CCL arrival; 5 had return of spontaneous circulation, 50 received ECLS, and all 55 received coronary angiography. Forty-six (84%) of 55 patients had significant CAD, 35 (64%) of 55 had acute thrombotic lesions, and 46 (84%) of 55 had percutaneous coronary intervention with 2.7 ± 2.0 stents deployed per patient. The mean SYNTAX score was 29.4 ± 13.9. Twenty-six (42%) of 62 patients were discharged alive with Cerebral Performance Category 1 or 2 versus 26 (15.3%) of 170 in the historical comparison group (odds ratio: 4.0; 95% confidence interval: 2.08 to 7.7; p < 0.0001). CONCLUSIONS: Complex but treatable CAD was prevalent in patients with refractory OH VF/VT cardiac arrest who also met criteria for continuing resuscitation in the CCL. A systems approach using ECLS and reperfusion seemed to improve functionally favorable survival.
Authors: Jerry P Nolan; Robert A Berg; Clifton W Callaway; Laurie J Morrison; Vinay Nadkarni; Gavin D Perkins; Claudio Sandroni; Markus B Skrifvars; Jasmeet Soar; Kjetil Sunde; Alain Cariou Journal: Intensive Care Med Date: 2018-06-02 Impact factor: 17.440
Authors: Guido Michels; Tobias Wengenmayer; Christian Hagl; Christian Dohmen; Bernd W Böttiger; Johann Bauersachs; Andreas Markewitz; Adrian Bauer; Jan-Thorsten Gräsner; Roman Pfister; Alexander Ghanem; Hans-Jörg Busch; Uwe Kreimeier; Andreas Beckmann; Matthias Fischer; Clemens Kill; Uwe Janssens; Stefan Kluge; Frank Born; Hans Martin Hoffmeister; Michael Preusch; Udo Boeken; Reimer Riessen; Holger Thiele Journal: Clin Res Cardiol Date: 2018-09-04 Impact factor: 5.460
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Med Klin Intensivmed Notfmed Date: 2018-09 Impact factor: 0.840
Authors: G Michels; T Wengenmayer; C Hagl; C Dohmen; B W Böttiger; J Bauersachs; A Markewitz; A Bauer; J-T Gräsner; R Pfister; A Ghanem; H-J Busch; U Kreimeier; A Beckmann; M Fischer; C Kill; U Janssens; S Kluge; F Born; H M Hoffmeister; M Preusch; U Boeken; R Riessen; H Thiele Journal: Anaesthesist Date: 2018-08 Impact factor: 1.041
Authors: Behnam N Tehrani; Alexander G Truesdell; Mitchell A Psotka; Carolyn Rosner; Ramesh Singh; Shashank S Sinha; Abdulla A Damluji; Wayne B Batchelor Journal: JACC Heart Fail Date: 2020-11 Impact factor: 12.035
Authors: Demetris Yannopoulos; Jason Bartos; Ganesh Raveendran; Emily Walser; John Connett; Thomas A Murray; Gary Collins; Lin Zhang; Rajat Kalra; Marinos Kosmopoulos; Ranjit John; Andrew Shaffer; R J Frascone; Keith Wesley; Marc Conterato; Michelle Biros; Jakub Tolar; Tom P Aufderheide Journal: Lancet Date: 2020-11-13 Impact factor: 79.321