Using Vascular Closure Devices Following Out-Of-Hospital Cardiac Arrest?

Abstract

Objectives and Background: Despite a generally broad use of vascular closure devices (VCDs), it remains unclear whether they can also be used in victims from out-of-hospital cardiac arrest (OHCA) treated with mild therapeutic hypothermia (MTH).Methods: All victims from OHCA who received immediate coronary angiography after OHCA between January 1st 2008 and December 31st 2013 were included in this study. The operator decided to either use a VCD (Angio-Seal™) or manual compression for femoral artery puncture. The decision to induce MTH was based on the clinical circumstances.Results: 76 patients were included in this study, 46 (60.5%) men and 30 (39.5%) women with a mean age of 64.2 ± 12.8 years. VCDs were used in 26 patients (34.2%), and 48 patients (63.2%) were treated with MTH. While there were significantly more overall vascular complications in the group of patients treated with MTH (12.5% versus 0.0%; p=0.05), vascular complications were similar between patients with VCD or manual compression, regardless of whether or not they were treated with MTH.Conclusion: In our study, the overall rate of vascular complications related to coronary angiography was higher in patients treated with mild therapeutic hypothermia, but was not affected by the application of a vascular closure device. Therefore, our data suggest that the use of VCDs in victims from OHCA might be feasible and safe in patients treated with MTH as well, at least if the decision to use them is individually carefully determined.

Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and Meta-Analysis

“…After removing 462 duplicate studies, step by step screening was performed based on inclusion and exclusion criteria. Eventually, 32 studies comprising 12 RCTs [28][29][30][31][32][33][34][35][36][37][38][39], 17 observational studies [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55], and 3 propensity-score matched studies [56][57][58] were included in this meta-analysis. Figure 1 shows the flowchart of inclusions and exclusions.…”

“…Vascular complication is the focus of attention and the most controversial issue. Previous researches have suggested that VCDs may lead to an increase in femoral artery thrombosis, arteriovenous fistula, pseudoaneurysm, and other adverse events [ 29 , 42 , 43 ]. However, the results of this meta-analysis showed that VCDs did not cause additional injury and may even improve the severity of complications.…”

Clinical and Subclinical Femoral Vascular Complications after Deployment of two Different Vascular Closure Devices or Manual Compression in the Setting of Coronary Intervention

“…They provide improved patient comfort and decreased time to ambulation (5). However, their impact on vascular complications is, at best, no different than manual compression and in some cases, possibly even worse 5 - 7 . The degree of uncertainty in VCD use is further aggravated by the fact, that our knowledge is based on few randomized studies and that these studies were mostly conducted in the setting of diagnostic procedures 5 .…”