Mechanical chest compressions in the coronary catheterization laboratory to facilitate coronary intervention and survival in patients requiring prolonged resuscitation efforts

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Göran K. Olivecrona³  Matthias Götberg³  Jan Harnek³  David Zughaft³  Malin Rundgren²  Bjarne Madsen Hardig¹  Henrik Wagner³ 

[1] Physio-Control Sweden/Jolife AB, Lund, Sweden;Department of Anaesthesiology and Intensive Care, Lund University, Lund, Sweden;Department of Cardiology, Lund University, Lund, Sweden

关键词: Survival;    Percutaneous coronary intervention;    Mechanical chest compressions;    Resuscitation;    Cardiac arrest;   

Others  :  1235665
DOI  :  10.1186/s13049-016-0198-3

 received in 2015-07-29, accepted in 2016-01-08,  发布年份 2016

【 摘 要 】

Background

Resuscitation after cardiac arrest (CA) in the catheterization laboratory (cath-lab) using mechanical chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is a strong recommendation in the 2015 European Resuscitation Council (ERC) guidelines. This study aimed at re-evaluating survival to hospital discharge and assess long term outcome in this patient population.

Methods

Patients presenting at the cath lab with spontaneous circulation, suffering CA and requiring prolonged mechanical CC during cath lab procedures between 2009 and 2013 were included. Circumstances leading to CA, resuscitation parameters and outcomes were evaluated within this cohort. For comparison, patients needing prolonged manual CC in the cath lab in the pre-mechanical CC era were evaluated. Six-month and one year survival with a mechanical CC treatment strategy from 2004 to 2013 was also evaluated.

Results

Thirty-two patients were included between 2009 and 2013 (24 ST-elevation myocardial infarction (STEMI), 4 non-STEMI, 2 planned PCI, 1 angiogram and 1 intra-aortic counter pulsation balloon pump insertion). Twenty were in cardiogenic shock prior to inclusion. Twenty-five were successfully treated with PCI. Median mechanical CC duration for the total cohort (n = 32) was 34 min (range 5–90), for the 15 patients with circulation discharged from the cath-lab, 15 min (range 5–90), and for the eight discharged alive from hospital, 10 min (range 5–52). Twenty-five percent survived with good neurological outcome at hospital discharge. Ten patients treated with manual CC were included with one survivor.

Discussion

Eighty-seven percent of the patients included in the mechanical CC cohort had their coronary or cardiac intervention performed during mechanical CC with an 80 % success rate. This shows that the use of mechanical CC during an intervention does not seem to impair the interventional result substantially. The survival rate after one year was 87 %.

Conclusions

Among patients suffering CA treated with mechanical CC in the cath-lab, 25 % had a good neurological outcome at hospital discharge compared to 10 % treated with manual CC. Long term survival in patients discharged from hospital is good.

【 授权许可】

   
2016 Wagner et al.

【 图 表 】

Fig. 1.

Fig. 1.

【 参考文献 】

• [1]Azman KJ, Gorjup V, Noc M. Rescue percutaneous coronary intervention during cardiopulmonary resuscitation. Resuscitation. 2004; 61(2):231-6.
• [2]Nielsen N, Sandhall L, Schersten F, Friberg H, Olsson SE. Successful resuscitation with mechanical CPR, therapeutic hypothermia and coronary intervention during manual CPR after out-of-hospital cardiac arrest. Resuscitation. 2005; 65(1):111-3.
• [3]Grogaard HK, Wik L, Eriksen M, Brekke M, Sunde K. Continuous mechanical chest compressions during cardiac arrest to facilitate restoration of coronary circulation with percutaneous coronary intervention. J Am Coll Cardiol. 2007; 50(11):1093-4.
• [4]Larsen AI, Hjornevik AS, Ellingsen CL, Nilsen DW. Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention. A report on the use of the LUCAS device. Resuscitation. 2007; 75(3):454-9.
• [5]Agostoni P, Cornelis K, Vermeersch P. Successful percutaneous treatment of an intraprocedural left main stent thrombosis with the support of an automatic mechanical chest compression device. Int J Cardiol. 2008; 124(2):e19-21.
• [6]Bonnemeier H, Simonis G, Olivecrona G, Weidtmann B, Gotberg M, Weitz G et al.. Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity. Resuscitation. 2011; 82(2):155-9.
• [7]Azadi N, Niemann JT, Thomas JL. Coronary imaging and intervention during cardiovascular collapse: use of the LUCAS mechanical CPR device in the cardiac catheterization laboratory. J Invasive Cardiol. 2012; 24(2):79-83.
• [8]Wagner H, Terkelsen CJ, Friberg H, Harnek J, Kern K, Lassen JF et al.. Cardiac arrest in the catheterisation laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation. 2010; 81(4):383-7.
• [9]Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM et al.. European Resuscitation Council Guidelines for Resuscitation 2015Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015; 95:148-201.
• [10]Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003; 362(9391):1225-30.
• [11]Wagner H, Rundgren M, Madsen Hardig B, Kern K, Zughaft D, Harnek J et al.. A structured approach for treatment of prolonged cardiac arrest cases in the coronary cathetrization laboratory using mechanical chest compressions. Int J Cardiovasc Res. 2013; 2(4):1-7.
• [12]Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA et al.. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med. 2009; 361(1):22-31.
• [13]Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367(20):1912-20.
• [14]Nolan JP, Soar J, Smith GB, Gwinnutt C, Parrott F, Power S et al.. Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit. Resuscitation. 2014; 85(8):987-92.
• [15]Fredriksson M, Aune S, Thoren AB, Herlitz J. In-hospital cardiac arrest--an Utstein style report of seven years’ experience from the Sahlgrenska University Hospital. Resuscitation. 2006; 68(3):351-8.
• [16]Chan PS, Spertus JA, Nallamothu BK. Long-term outcomes in elderly survivors of cardiac arrest. N Engl J Med. 2013; 368(25):2438-9.
• [17]Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 1(7905):480-4.
• [18]Nicklas JM, Diltz EA, O'Neill WW, Bourdillon PD, Walton JA, Pitt B. Quantitative measurement of coronary flow during medical revascularization (thrombolysis or angioplasty) in patients with acute infarction. J Am Coll Cardiol. 1987; 10(2):284-9.
• [19]Herlitz J. Swedish Cardiopulmonary Resuscitation Registry. 2013. Yearly report of cardiac arrest reported to the Swedish cardiopulmonary resucitation registry
• [20]Wallmuller C, Meron G, Kurkciyan I, Schober A, Stratil P, Sterz F. Causes of in-hospital cardiac arrest and influence on outcome. Resuscitation. 2012; 83(10):1206-11.
• [21]Demidova MM, Carlson J, Erlinge D, Platonov PG. Predictors of ventricular fibrillation at reperfusion in patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Am J Cardiol. 2014; 115(4):417-22.
• [22]Tadel-Kocjancic S, Zorman S, Jazbec A, Gorjup V, Zorman D, Noc M. Effectiveness of primary percutaneous coronary intervention for acute ST-elevation myocardial infarction from a 5-year single-center experience. Am J Cardiol. 2008; 101(2):162-8.
• [23]Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P et al.. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003; 349(8):733-42.
• [24]Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD et al.. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock? N Engl J Med. 1999; 341(9):625-34.
• [25]Hochman JS, Sleeper LA, White HD, Dzavik V, Wong SC, Menon V et al.. One-year survival following early revascularization for cardiogenic shock. JAMA. 2001; 285(2):190-2.
• [26]Minha S, Barbash IM, Dvir D, Ben-Dor I, Loh JP, Pendyala LK et al.. Correlates for mortality in patients presented with acute myocardial infarct complicated by cardiogenic shock. Cardiovasc Revasc Med. 2014; 15(1):13-7.
• [27]Gupta N, Kontos MC, Gupta A, Dai D, Vetrovec GW, Roe MT et al.. Characteristics and outcomes in patients undergoing percutaneous coronary intervention following cardiac arrest (from the NCDR). Am J Cardiol. 2014; 113(7):1087-92.
• [28]Arlt M, Philipp A, Voelkel S, Schopka S, Husser O, Hengstenberg C et al.. Early experiences with miniaturized extracorporeal life-support in the catheterization laboratory. Eur J Cardiothorac Surg. 2012; 42(5):858-63.
• [29]Kagawa E, Dote K, Kato M, Sasaki S, Nakano Y, Kajikawa M et al.. Should we emergently revascularize occluded coronaries for cardiac arrest? Rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation. 2012; 126(13):1605-13.
• [30]Mooney MR, Hildebrandt D, Feldman D, Sun B, Rilla D, Wang Y et al.. Level 1 shock team-early experince in ECMO use as a rescue device in cardiac arrest from STEMI in the cardiac catheterization laboratory. J Am Coll Cardiol. 2013.
• [31]Aoyama N, Imai H, Kurosawa T, Fukuda N, Moriguchi M, Nishinari M et al.. Therapeutic strategy using extracorporeal life support, including appropriate indication, management, limitation and timing of switch to ventricular assist device in patients with acute myocardial infarction. J Artif Organs. 2013; 17(1):33-41.
• [32]Danshockinvestigatorerne T. of cardiogenic shock with percutanous mechanical circulatory support. Ugeskr Laeger. 2013; 175(4):205-8.
• [33]Belohlavek J, Kucera K, Jarkovsky J, Franek O, Pokorna M, Danda J et al.. Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. “Prague OHCA study”. J Transl Med. 2012; 10:163. BioMed Central Full Text