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Background-Extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI) may be useful in cardiopulmonary resuscitation. 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 patients with cardiac arrest complicated by acute coronary syndrome who were unresponsive to conventional cardiopulmonary resuscitation. Methods and Results-This multicenter cohort study was conducted with the use of the database of ECMO in Hiroshima City, Japan. Between January 2004 and May 2011, rapid-response ECMO was performed in 86 patients with acute coronary syndrome who were unresponsive to conventional CPR. The median age of the study patients was 63 years, 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 heartbeat, 30-day survival, and favorable neurological outcomes were 88%, 29%, and 24%, respectively. All of the patients who received intra-arrest PCI achieved return of spontaneous heartbeat. In patients who survived up to day 30, the rate of out-of-hospital cardiac arrest was lower (58% versus 28%; Pϭ0.01), the intra-arrest PCI was higher (88% versus 70%; Pϭ0.04), and the time interval from collapse to the initiation of ECMO was shorter (40 [25-51] versus 54 minutes [34 -74 minutes]; Pϭ0.002). Conclusions-Rapid-response ECMO plus intra-arrest PCI is feasible and associated with improved outcomes in patients who are unresponsive to conventional cardiopulmonary resuscitation. On the basis of these findings, randomized studies of intra-arrest PCI are needed. (Circulation. 2012;126:1605-1613.)Key Words: acute coronary syndrome Ⅲ cardiac arrest Ⅲ cardiopulmonary bypass Ⅲ cardiopulmonary resuscitation Ⅲ extracorporeal membrane oxygenation C ardiac arrest is a major cause of unexpected death in developed countries and has a poor prognosis. Despite cardiopulmonary resuscitation (CPR), only a few patients are able to return to their former lifestyle. 1-5 Extracorporeal CPR (ECPR), an alternative to conventional CPR that employs extracorporeal membrane oxygenation (ECMO), has been reported to be effective for patients in whom return of spontaneous circulation (ROSC) cannot be achieved by conventional CPR. 6 -8 ECMO provides adequate temporary perfusion to organs in cardiac arrest patients before return of spontaneous heartbeat (ROSB). ECMO increases the rate of successful defibrillation, prevents rearrest due to postresuscitation myocardial dysfunction, and enables subsequent interventions. 9 Conversely, there are some cardiac arrest patients in whom ROSB is not achieved despite temporary mechanical circulatory assistance by venoarterial ECMO. A high incidence of acute coronary syndrome (ACS) is reported in cardiac arrest patients, and it has been noted recently that the use of percutaneous coronary intervention (PCI) in postresuscitation care improves their outcome. 6,10 -14 In...

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