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Coronary lesions in refractory out of hospital cardiac arrest (OHCA) treated by extra corporeal pulmonary resuscitation (ECPR)

  • Author Footnotes
    1 Authors contributed equally.
    Lionel Lamhaut
    Correspondence
    Corresponding author at: SAMU de Paris-DAR Necker University Hospital-Assistance Public Hopitaux de Paris, Paris, France.
    Footnotes
    1 Authors contributed equally.
    Affiliations
    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
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  • Author Footnotes
    1 Authors contributed equally.
    Victoria Tea
    Footnotes
    1 Authors contributed equally.
    Affiliations
    Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France
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  • Jean-Herlé Raphalen
    Affiliations
    SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France

    Paris Descartes University, Paris, France
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  • Kim An
    Affiliations
    SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France
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  • Christelle Dagron
    Affiliations
    SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France
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  • Romain Jouffroy
    Affiliations
    SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France
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  • Xavier Jouven
    Affiliations
    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
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  • Alain Cariou
    Affiliations
    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
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  • Frédéric Baud
    Affiliations
    SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France
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  • Christian Spaulding
    Affiliations
    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
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  • Albert Hagege
    Affiliations
    Paris Descartes University, Paris, France

    Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France
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  • Nicolas Danchin
    Affiliations
    Paris Descartes University, Paris, France

    Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France
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  • Pierre Carli
    Affiliations
    SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France

    Paris Descartes University, Paris, France
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  • Author Footnotes
    1 Authors contributed equally.
    Alice Hutin
    Footnotes
    1 Authors contributed equally.
    Affiliations
    SAMUde Paris-DAR Necker University Hospital-Assistance, Paris, France

    Inserm, U955, Equipe 03, F94000, Créteil, France
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  • Author Footnotes
    1 Authors contributed equally.
    Etienne Puymirat
    Footnotes
    1 Authors contributed equally.
    Affiliations
    Paris Descartes University, Paris, France

    Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France
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  • Author Footnotes
    1 Authors contributed equally.

      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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