TY - JOUR
T1 - Cardiac Arrest in the Cardiac Catheterization Laboratory
T2 - Combining Mechanical Chest Compressions and Percutaneous LV Assistance
AU - Lotun, Kapildeo
AU - Truong, Huu Tam
AU - Cha, Kyoung Chul
AU - Alsakka, H.
AU - Gianotto-Oliveira, R.
AU - Smith, Nicole
AU - Rao, Prashant
AU - Bien, T.
AU - Chatelain, S.
AU - Kern, Matthew C.
AU - Hsu, Chiu Hsieh
AU - Zuercher, Mathias
AU - Kern, Karl B.
N1 - Funding Information:
Dr. Kern was supported by funding from Physio-Control Inc. (investigator-initiated research project) and the Steven M. Gootter Foundation (Tucson, Arizona); and has served as a science advisory board member and received an investigator-initiated research project from Physio-Control Inc., which markets the LUCAS device. Dr. Lotun has served on the new product development advisory board for Abiomed, which markets the Impella Device; has served as a proctor for Medtronic; and is on the Speakers Bureau for LivaNova. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/9/23
Y1 - 2019/9/23
N2 - 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.
AB - 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.
KW - CPR
KW - cardiac arrest
KW - coronary angiography and intervention
KW - mechanical support
KW - myocardial perfusion
KW - systemic perfusion
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U2 - 10.1016/j.jcin.2019.05.016
DO - 10.1016/j.jcin.2019.05.016
M3 - Article
C2 - 31537284
AN - SCOPUS:85071865120
SN - 1936-8798
VL - 12
SP - 1840
EP - 1849
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 18
ER -