Should We Emergently Revascularize Occluded Coronaries for Cardiac Arrest?: Rapid-Response Extracorporeal Membrane Oxygenation and Intra-Arrest Percutaneous Coronary Intervention

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.