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.
Keywords
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Article info
Publication history
Published online: December 15, 2017
Accepted:
December 14,
2017
Received in revised form:
November 26,
2017
Received:
September 21,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2017.12.017.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
