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

Kapildeo Lotun; Huu Tam Truong; Kyoung-Chul Cha; Hanan Alsakka; Renan Gianotto-Oliveira; Nicole Smith; Prashant Rao; Tyler Bien; Shaun Chatelain; Matthew C Kern; Chiu-Hsieh Hsu; Mathias Zuercher; Karl B Kern

doi:10.1016/j.jcin.2019.05.016

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

JACC Cardiovasc Interv. 2019 Sep 23;12(18):1840-1849. doi: 10.1016/j.jcin.2019.05.016.

Authors

Affiliations

¹ Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona.
² Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju-si, Republic of Korea.
³ Department of Medicine, Heart Institute (InCor), School of Medicine, Sao Paulo University, Sao Paulo, Brazil.
⁴ University of Arizona College of Public Health, Tucson, Arizona.
⁵ Department of Anesthesiology, University of Basel, Basel, Switzerland.
⁶ Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona. Electronic address: [email protected].

PMID: 31537284
DOI: 10.1016/j.jcin.2019.05.016

Abstract

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.

Keywords: CPR; cardiac arrest; coronary angiography and intervention; mechanical support; myocardial perfusion; systemic perfusion.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Animals
Cardiac Catheterization / adverse effects*
Combined Modality Therapy
Disease Models, Animal
Female
Heart Arrest / diagnosis
Heart Arrest / etiology
Heart Arrest / physiopathology
Heart Arrest / therapy*
Heart Massage / instrumentation*
Heart-Assist Devices*
Hemodynamics
Male
Percutaneous Coronary Intervention / adverse effects*
Recovery of Function
Sus scrofa
Time Factors
Ventricular Fibrillation / diagnosis
Ventricular Fibrillation / etiology
Ventricular Fibrillation / physiopathology
Ventricular Fibrillation / therapy*
Ventricular Function, Left*