The result of emergency cardiac intervention in resuscitated out-of-hospital cardiac arrest patients
Hsieh Ming-Yu1, Hsien-Hua Liao2, Shih-Chen Tsai3, Ying-Hock Teng4, Po-Yu Chen3, Su-Chin Tsao5, Ching-Feng Tsai6, Kuei-Chuan Chan6, Jung-Ming Yu7, Yi-Liang Wu5, Tsung-Po Tsai5
1 Department of Surgery, Chung Shan Medical University Hospital; Department of Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
2 Department of Surgery, Chung Shan Medical University Hospital; College of Medicine, Chung Shan Medical University, Taichung, Taiwan
3 College of Medicine, Chung Shan Medical University, Taichung, Taiwan
4 College of Medicine, Chung Shan Medical University; Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
5 Department of Institute of Medicine, Chung Shan Medical University; Division of Cardiovascular Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
6 Department of Institute of Medicine, Chung Shan Medical University; Division of Cardiology, Chung Shan Medical University Hospital, Taichung, Taiwan
7 Division of Cardiovascular Surgery, Tzu Chi Hospital, Taichung; College of Medicine, Tzu Chi University, Hualien, Taiwan
Prof. Tsung-Po Tsai
Division of Cardiovascular Surgery, College of Medicine, Chung Shan Medical University Hospital, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung City 40201
Source of Support: None, Conflict of Interest: None
Background: Arrhythmia and sudden cardiac decompensation (acute myocardial infarct or acute heart failure) are the most often causes of out-of-hospital cardiac arrest (OHCA). Emergency cardiac catheterization followed by coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting surgery [CABG]) or valvular surgery is a lifesaving procedure. However, the result of this emergency room resuscitated OHCA patients underwent cardiac invasive procedure was not well defined before.
Materials and Methods: One hundred and seventy (including 23 traumatic and stroke, etc.,) out of 705 OHCA patients were resuscitated and achieved a return of spontaneous circulation (ROSC) at Emergency Room of Chung Shan Medical University Hospital from January 1, 2011, to March 31, 2015. Only 23 (M/F = 25/8) out of 147 medically resuscitated OHCA patient with one or more cardiac risk factors were transferred for emergency cardiac catheterization (33/147). Thirty-one of them (31/33) underwent PCI (either balloon angioplasty or stent deployment) with coronary culprit stenotic lesions (>70%) of right coronary artery (15), left anterior descending artery (12), circumflex branch of left coronary artery (5), and left main coronary artery (1). One of the rest two patients with aortic valvular stenosis who underwent aortic valve replacement; and another with triple vessel disease of coronary artery received CABG.
Results: All 33 patients (22.4%) survived the catheterization procedures and were sent to intensive care units. 31 patients were in comatose state and 24 eventually deceased due to cardiogenic shock (16), septic shock (4), ventricular tachycardia and ventricular fibrillation (2), hyperkalemia (1) and multiple organ failure (1). Nine patients (27.3%) survived to hospital discharge and were followed up at OPD periodically (1.3–43 months, mean 30.4 months). Four OHCA patients required extra-corporeal membrane oxygenation support, but only one out of four underwent PCI and survived.
Conclusions: The resuscitated OHCA (ROSC) patients with any cardiac disease in the past should undergo emergency cardiac catheterization and possible intervention procedure with an acceptable result (survival to hospital discharge rate of 27.3%).