Lionel Lamhaut1, Victoria Tea2, Jean-Herlé Raphalen3, Kim An4, Christelle Dagron4, Romain Jouffroy4, Xavier Jouven5, Alain Cariou6, Frédéric Baud4, Christian Spaulding5, Albert Hagege7, Nicolas Danchin7, Pierre Carli3, Alice Hutin8, Etienne Puymirat7. 1. SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France; Paris Descartes University, Paris, France; INSERM U970 Team 4 "Sudden Death Expertise Center", Paris, France, France. Electronic address: lionel@lamhaut.fr. 2. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France. 3. SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France; Paris Descartes University, Paris, France. 4. SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France. 5. Paris Descartes University, Paris, France; INSERM U970 Team 4 "Sudden Death Expertise Center", Paris, France, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France. 6. Paris Descartes University, Paris, France; INSERM U970 Team 4 "Sudden Death Expertise Center", Paris, France, France; Medical ICU, Cochin University Hospital-Assistance Public Hopitaux de Paris; Paris; France, France. 7. Paris Descartes University, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France. 8. SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France; Inserm, U955, Equipe 03, F94000, Créteil, France.
Abstract
PURPOSE: Extracorporeal cardiopulmonary resuscitation (ECPR) is a second line treatment for refractory cardiac arrest (R-OHCA). Timing of ECPR before performing coronary angiography (CAG) is still debated. The aim of the study was to describe the clinical and angiographic characteristics of the largest cohort of out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR. METHODS: All refractory OHCA patients with ECPR managed by the prehospital mobile intensive care unit (MoICU of the SAMU) in Paris (France) were prospectively included from October 2014 to December 2016. RESULTS: Among 74 patients included over the period, 54 patients had coronary artery disease (CAD). There is a trend toward the CAD patients being older but it did not meet statistical significance (55.3 ± 11.8 vs. 50.6 ± 12.8, p = 0,14). Patients were more frequently men and smokers (p = 0.03 for both). The proportion of initial shockable rhythm tended to be higher in patients with CAD (71% vs. 55%). The rate of 1-, 2-, and 3-vessel disease were 43%, 35% and 22% respectively. The Syntax Score was 18 ± 9 and the lesions in each epicardial vessel were mainly proximal. Percutaneous coronary intervention was performed ad hoc in 49 patients (91%). Complete revascularization was performed in 64%. Inhospital death was numerically lower (65% vs. 75%) in patients with CAD, especially in patients with initial shockable rhythm. CONCLUSION: In 74 refractory OHCA patients treated with ECPR implanted by a prehospital mobile intensive care unit, the rate of CAD was high (54/74) especially in patients with shockable rhythm. The majority of patients presented with double or triple vessel disease and proximal lesions. The severity and extension of CAD may explain the refractory nature of the cardiac arrest.
PURPOSE: Extracorporeal cardiopulmonary resuscitation (ECPR) is a second line treatment for refractory cardiac arrest (R-OHCA). Timing of ECPR before performing coronary angiography (CAG) is still debated. The aim of the study was to describe the clinical and angiographic characteristics of the largest cohort of out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR. METHODS: All refractory OHCA patients with ECPR managed by the prehospital mobile intensive care unit (MoICU of the SAMU) in Paris (France) were prospectively included from October 2014 to December 2016. RESULTS: Among 74 patients included over the period, 54 patients had coronary artery disease (CAD). There is a trend toward the CAD patients being older but it did not meet statistical significance (55.3 ± 11.8 vs. 50.6 ± 12.8, p = 0,14). Patients were more frequently men and smokers (p = 0.03 for both). The proportion of initial shockable rhythm tended to be higher in patients with CAD (71% vs. 55%). The rate of 1-, 2-, and 3-vessel disease were 43%, 35% and 22% respectively. The Syntax Score was 18 ± 9 and the lesions in each epicardial vessel were mainly proximal. Percutaneous coronary intervention was performed ad hoc in 49 patients (91%). Complete revascularization was performed in 64%. Inhospital death was numerically lower (65% vs. 75%) in patients with CAD, especially in patients with initial shockable rhythm. CONCLUSION: In 74 refractory OHCA patients treated with ECPR implanted by a prehospital mobile intensive care unit, the rate of CAD was high (54/74) especially in patients with shockable rhythm. The majority of patients presented with double or triple vessel disease and proximal lesions. The severity and extension of CAD may explain the refractory nature of the cardiac arrest.
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
Authors: D Duerschmied; V Zotzmann; M Rieder; X Bemtgen; P M Biever; K Kaier; G Trummer; C Benk; H J Busch; C Bode; T Wengenmayer; P Stachon; C von Zur Mühlen; D L Staudacher Journal: Sci Rep Date: 2020-05-21 Impact factor: 4.379