The use of prehospital variables to predict acute coronary artery disease in failed resuscitation attempts for out-of-hospital cardiac arrest

Youngquist, Scott T.; Hartsell, Sydney; McLaren, Daryl; Hartsell, Stephen

doi:10.1016/j.resuscitation.2015.04.021

Cited by 14 publications

(8 citation statements)

References 34 publications

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“…Patients with initial shockable rhythm have considered to be associated with higher risk of myocardial infarction (MI) as an origin for OHCA and are likely to be referred for ICA 2736. Youngquist et al37 investigated 151 autopsy cases of OHCA patients with failed resuscitation and found that 43% of the OHCA cases were related to coronary occlusion. They also stated that old age and initial shockable rhythm were associated with CAD, which is consistent with ours.…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Obstructive Coronary Artery Disease in Patients with Out-of-Hospital Cardiac Arrest: Data from the Korean Cardiac Arrest Research Consortium (KoCARC) Registry

et al. 2019

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Background Although coronary artery disease (CAD) is a major cause of out-of-hospital cardiac arrest (OHCA), there has been no convinced data on the necessity of routine invasive coronary angiography (ICA) in OHCA. We investigated clinical factors associated with obstructive CAD in OHCA. Methods Data from 516 OHCA patients (mean age 58 years, 83% men) who underwent ICA after resuscitation was obtained from a nation-wide OHCA registry. Obstructive CAD was defined as the lesions with diameter stenosis ≥ 50% on ICA. Independent clinical predictors for obstructive CAD were evaluated using multiple logistic regression analysis, and their prediction performance was compared using area under the receiver operating characteristic curve with 10,000 repeated random permutations. Results Among study patients, 254 (49%) had obstructive CAD. Those with obstructive CAD were older (61 vs. 55 years, P < 0.001) and had higher prevalence of hypertension (54% vs. 36%, P < 0.001), diabetes mellitus (29% vs. 21%, P = 0.032), positive cardiac enzyme (84% vs. 74%, P = 0.010) and initial shockable rhythm (70% vs. 61%, P = 0.033). In multiple logistic regression analysis, old age (≥ 60 years) (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.36–3.00; P = 0.001), hypertension (OR, 1.74; 95% CI, 1.18–2.57; P = 0.005), positive cardiac enzyme (OR, 1.72; 95% CI, 1.09–2.70; P = 0.019), and initial shockable rhythm (OR, 1.71; 95% CI, 1.16–2.54; P = 0.007) were associated with obstructive CAD. Prediction ability for obstructive CAD increased proportionally when these 4 factors were sequentially combined ( P < 0.001). Conclusion In patients with OHCA, those with old age, hypertension, positive cardiac enzyme and initial shockable rhythm were associated with obstructive CAD. Early ICA should be considered in these patients.

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Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with Obstructive Coronary Artery Disease in Patients with Out-of-Hospital Cardiac Arrest: Data from the Korean Cardiac Arrest Research Consortium (KoCARC) Registry

et al. 2019

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“…Second, our ECPR protocol involves immediate coronary angiography and percutaneous coronary interventions (PCI), as warranted. As an appreciable proportion of cardiac arrests are due to acute coronary ischaemia [23], and PCI is itself independently associated with improved myocardial function and survival [24][25][26][27][28], we assessed this and found that PCI was not independently associated with myocardial function in our study. Thirdly, the use of the ECLS circuit enables perfusion independent of myocardial function.…”

Section: Discussionmentioning

confidence: 85%

Exploratory analysis of myocardial function after extracorporeal cardiopulmonary resuscitation vs conventional cardiopulmonary resuscitation

et al. 2020

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Objective: Ventricular unloading is associated with myocardial recovery. We sought to evaluate the association of extracorporeal cardiopulmonary resuscitation (ECPR) on myocardial function after cardiac arrest. We conducted a retrospective exploratory analysis, comparing ejection fraction (EF) after adult cardiac arrest, between ECPR and conventional CPR. Results: Among 1119 cases of cardiac arrest, 116 had an echocardiogram post-return of spontaneous circulation (ROSC) and were included. Thirty-eight patients had ≥ 2 echocardiograms. ECPR patients had differences in age, hypertension and chronic heart failure. ECPR patients had a lower EF post-ROSC (24% vs 45%; p < 0.01) and were more likely to undergo percutaneous coronary intervention (25% vs 3%; p < 0.01). In multivariate analysis, only ECPR use (β-coeff: 10.4 [95% CI 3.68-17.13]; p < 0.01) independently predicted improved myocardial function. In this exploratory study, EF after cardiac arrest may be more likely to improve among ECPR patients than CCPR patients. Our methodology should be replicated to confirm or refute the validity of our findings.

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“…Percutaneous coronary intervention (PCI) is arguably required for ECPR with initial shockable rhythms, if not also in cases where noncoronary causes of arrest can be excluded. Acute thrombotic occlusive coronary lesions, with or without ST elevation on EKG, are leading causes of sudden OHCA with initial shockable rhythms 42 . Although the COACT trial demonstrated that immediate PCI in initial nonshockable rhythm OHCA was not beneficial, 43 ECPR patients by definition have refractory arrest at the time of cannulation, making them distinct in this regard from the patients in the COACT trial who achieved ROSC.…”

Section: Ecpr Implementationmentioning

confidence: 99%

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Ciullo,

Tonna

2024

JACEP Open

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Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged in the context of the emergency department as a life‐saving therapy for patients with refractory cardiac arrest. This review examines the utility of ECPR based on current evidence gleaned from three pivotal trials: the ARREST trial, the Prague study, and the INCEPTION trial. We also discuss several considerations in the care of these complex patients, including prehospital strategy, patient selection, and postcardiac arrest management. Collectively, the evidence from these trials emphasizes the growing significance of ECPR as a viable intervention, highlighting its potential for improved outcomes and survival rates in patients with refractory cardiac arrest when employed judiciously. As such, these findings advocate the need for further research and protocol development to optimize its use in diverse clinical scenarios.

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The use of prehospital variables to predict acute coronary artery disease in failed resuscitation attempts for out-of-hospital cardiac arrest

Cited by 14 publications

References 34 publications

Clinical Factors Associated with Obstructive Coronary Artery Disease in Patients with Out-of-Hospital Cardiac Arrest: Data from the Korean Cardiac Arrest Research Consortium (KoCARC) Registry

Clinical Factors Associated with Obstructive Coronary Artery Disease in Patients with Out-of-Hospital Cardiac Arrest: Data from the Korean Cardiac Arrest Research Consortium (KoCARC) Registry

Exploratory analysis of myocardial function after extracorporeal cardiopulmonary resuscitation vs conventional cardiopulmonary resuscitation

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

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