Should We Emergently Revascularize Occluded Coronaries for Cardiac Arrest? Rapid-Response Extracorporeal Membrane Oxygenation and Intra-Arrest Percutaneous Coronary Intervention
Should We Emergently Revascularize Occluded Coronaries for Cardiac Arrest? Rapid-Response Extracorporeal Membrane Oxygenation and Intra-Arrest Percutaneous Coronary Intervention
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DOI：
10.1161/circulationaha.111.067538
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发表时间：
2012-09-25
期刊：
影响因子：
37.8
通讯作者：
Kurisu, Satoshi
中科院分区：
文献类型：
--
作者：
Kagawa, Eisuke;Dote, Keigo;Kurisu, Satoshi
背景-体外膜肺氧合(ECMO)和经皮冠状动脉介入治疗(PCI)在心肺复苏中可能是有用的。然而，对ECMO和急诊经皮冠状动脉介入治疗的结合知之甚少。本研究以日本广岛市ECMO数据库为基础，研究了快速反应ECMO和停搏内经皮冠状动脉介入治疗对常规心肺复苏无效的心脏骤停合并急性冠脉综合征患者的疗效。2004年1月至2011年5月，对86例常规心肺复苏术无效的急性冠脉综合征患者进行了快速反应ECMO。研究患者的平均年龄为63岁，其中81%是男性。81例(94%)行急诊冠状动脉造影术，61例(71%)行体外循环介入治疗。自主心跳恢复率、30天存活率和神经功能恢复良好率分别为88%、29%和24%。所有接受心内直视手术的患者均恢复自主心跳。存活至30天的患者，院外心脏骤停发生率较低(58%比28%；P=0.01)，心内直视手术发生率高(88%比70%；P=0.04)，从崩溃到开始体外循环的时间较短(40分钟[25-51分钟]比54分钟[34-74分钟]；P=0.002)。基于这些发现，需要对急诊介入治疗进行随机研究。(发行量。2012；126：1605-1613。)
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%; P=0.01), the intra-arrest PCI was higher (88% versus 70%; P=0.04), and the time interval from collapse to the initiation of ECMO was shorter (40 [25-51] versus 54 minutes [34-74 minutes]; P=0.002).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.)