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Should We Emergently Revascularize Occluded Coronaries for Cardiac Arrest?: Rapid-Response Extracorporeal Membrane Oxygenation and Intra-Arrest Percutaneous Coronary Intervention.
MedLine Citation:
PMID:  22899771     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI) may be useful in cardiopulmonary resuscitation (CPR). However, little is known about the combination of ECMO and intra-arrest PCI. This study investigated the efficacy of rapid-response ECMO and intra-arrest PCI in cardiac arrest patients who were unresponsive to conventional CPR complicated with acute coronary syndrome (ACS). METHODS AND RESULTS: This multicentre cohort study was conducted using the database of ECMO in Hiroshima City. Between January 2004 and May 2011, rapid-response ECMO was performed in 86 patients with ACS who were unresponsive to conventional CPR. The median age of the study patients was 63 years old, and 81% were male. Emergency coronary angiography was performed in 81 patients (94%) and intra-arrest PCI was performed in 61 patients (71%). The rates of return of spontaneous heart-beat, 30-day survival, and favourable neurological outcomes were 88%, 29%, and 24%, respectively. All of the patients who received intra-arrest PCI achieved return of spontaneous heart-beat. In patients who survived up to day 30, the rate of out-of-hospital cardiac arrest was lower (58% vs. 28%, P = 0.01), the intra-arrest PCI was higher (88% vs. 70%, P = 0.04), and the time interval from collapse to the initiation of ECMO was shorter (40 min [25-51 min] vs. 54 min [34-74 min], P = 0.002). CONCLUSIONS: Rapid-response ECMO plus intra-arrest PCI is feasible and associated with improved outcomes in patients who are unresponsive to conventional CPR. Based on these findings, randomized studies of intra-arrest PCI are needed.
Authors:
Eisuke Kagawa; Keigo Dote; Masaya Kato; Shota Sasaki; Yoshinori Nakano; Masato Kajikawa; Akifumi Higashi; Kiho Itakura; Akihiko Sera; Ichiro Inoue; Takuji Kawagoe; Masaharu Ishihara; Yuji Shimatani; Satoshi Kurisu
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-16
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Hiroshima City Asa Hospital, Hiroshima, Japan;
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