Cardiac Arrest in the Cardiac Catheterization Laboratory: Combining Mechanical Chest Compressions and Percutaneous LV Assistance

Objectives: The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory. Background: CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion. These include manual chest compressions, mechanical chest compressions, or a percutaneous left ventricular assist device. Methods: Eighty swine (58 ± 10 kg) were studied. The left main or proximal left anterior descending artery was occluded. Ventricular fibrillation (VFCA) was induced and circulatory support was provided with 1 of 4 techniques: either manual chest compressions (frequently interrupted), mechanical chest compressions with a piston device (LUCAS-2), an Impella 2.5 L percutaneously placed LVAD, or the combination of mechanical chest compressions and the percutaneous left ventricular assist device. The study protocol included 12 min of left main coronary occlusion, reperfusion, with defibrillation attempted after 15 min of VFCA. Primary outcome was favorable neurological function (CPC 1 or 2) at 24 h, while secondary outcomes included return of spontaneous circulation and hemodynamics. Results: Manual chest compressions provided fewer neurologically intact surviving animals than the combination of a mechanical chest compressor and a percutaneous LVAD device (0% vs. 56%; p < 0.01), while no difference was found between the 2 mechanical approaches (28% vs. 35%: p = 0.75). Comparing integrated coronary perfusion pressure showed sequential improvement in hemodynamic support with mechanical devices (401 ± 230 vs. 1,337 ± 905 mm Hg/s; p = 0.06). Conclusions: Combining 2 mechanical devices provided superior 24-h survival with favorable neurological recovery compared with manual compressions during moderate duration VFCA associated with an acute coronary occlusion in the animal catheterization laboratory.