Lamhaut L, et al. - The study was planned to delineate the clinical and angiographic characteristics of the largest cohort of out-of-hospital cardiac arrest (OHCA) patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Observation revealed a high rate of coronary artery disease (CAD) (54/74) among 74 refractory OHCA patients treated with ECPR implanted by a prehospital mobile intensive care unit. This was particularly observed in patients with shockable rhythm. The majority of patients here reported double or triple vessel disease and proximal lesions. The refractory nature of the cardiac arrest could be described with the severity and extension of CAD.

Methods

• Researchers prospectively included all refractory OHCA patients with ECPR managed by the prehospital mobile intensive care unit (MoICU of the SAMU) in Paris (France) from October 2014 to December 2016.

Results

• Researchers included 74 patients during the study period, 54/74 patients had coronary artery disease (CAD).
• A trend toward the CAD patients being older was noticed, however, it did not meet statistical significance (55.3 ± 11.8 vs. 50.6 ± 12.8, p=0,14).
• In this study, identified patients were more frequently men and smokers (p=0.03 for both).
• Patients with CAD, in a higher proportion, indicated initial shockable rhythm (71% vs. 55%).
• Data revealed that the rate of 1-, 2-, and 3-vessel disease were 43%, 35% and 22% respectively.
• The Syntax Score of 18 ± 9 was observed; mainly proximal lesions in each epicardial vessel were noticed.
• In 49 patients (91%), they performed percutaneous coronary intervention ad hoc.
• In 64%, they performed complete revascularization.
• Patients with CAD indicated numerically lower inhospital death (65% vs 75%); this was particularly evident in patients with initial shockable rhythm.