Author + information
- Received May 14, 2017
- Revision received June 21, 2017
- Accepted June 22, 2017
- Published online August 21, 2017.
- Demetris Yannopoulos, MDa,∗ (, )
- Jason A. Bartos, MD, PhDa,
- Ganesh Raveendran, MDa,
- Marc Conterato, MDb,
- Ralph J. Frascone, MDc,
- Alexander Trembley, BSb,
- Ranjit John, MD, PhDd,
- John Connett, PhDe,
- David G. Benditt, MDa,
- Keith G. Lurie, MDa,
- Robert F. Wilson, MDa and
- Tom P. Aufderheide, MDf
- aDivision of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota
- bDepartment of Emergency Medicine, North Memorial Medical Center, Robbinsdale, Minnesota
- cDepartment of Emergency Medicine, Regions Hospital, St. Paul, Minnesota
- dDivision of Cardiothoracic Surgery, University of Minnesota School of Medicine, Minneapolis, Minnesota
- eDivision of Biostatistics, University of Minnesota, Minneapolis, Minnesota
- fDepartment of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- ↵∗Address for correspondence:
Dr. Demetris Yannopoulos, University of Minnesota, UMN–Cardiology Division, 420 Delaware Street SE, MMC 508, Minneapolis, Minnesota 55455.
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.
This work was supported by a philanthropic gift of the Bakken Family and the Robert K. Eddy Endowment for Resuscitation Medicine. Dr. Benditt has served as a consultant for Medtronic and Zoll; and has equity in Medtronic and Abbott. Dr. Lurie has a patent for impedance threshold and active compression-decompression devices with royalties paid; and is a consultant for Zoll. Dr. Aufderheide has served as the primary investigator for studies sponsored by JDP Therapeutics and Hospital Quality Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 14, 2017.
- Revision received June 21, 2017.
- Accepted June 22, 2017.
- 2017 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.