Background: The incidence of coronary artery disease (CAD) among patients with refractory out-of-hospital (OOH) ventricular fibrillation/ventricular tachycardia (VF/VT) cardiac arrest is unknown.
Objectives: This study sought to describe the prevalence and complexity of coronary artery disease and report survival to hospital discharge in patients suffering refractory VF/VT cardiac arrest treated with a novel protocol of early transport to cardiac catheterization laboratory (CCL) for ECLS and revascularization.
Methods: Between December 1, 2015 and December 1, 2016, consecutive adult patients with refractory OOH VF/VT cardiac arrest requiring ongoing CPR were transported by emergency medical services (EMS) to the CCL. ECLS, coronary angiography, and percutaneous coronary intervention (PCI) were performed, as appropriate. Functionally favorable survival to hospital discharge (Cerebral Performance Category [CPC] 1 or 2) was determined. Outcomes in a historical comparison group were also evaluated.
Results: Sixty-two of 72 (86%) transported patients met EMS transport criteria; 55/62 (89%) met criteria for continuing resuscitation on CCL arrival; 5 had ROSC; 50 received ECLS; all 55 received coronary angiography. Forty-six of 55 (84%) had significant CAD, 35/55 (64%) had acute thrombotic lesions, and 46/55 (84%) had PCI with 2.7±2.0 stents deployed per patient. The mean Syntax Score was 29.4±13.9. Twenty-six of 62 (42%) patients were discharged alive with CPC 1 or 2 versus 26/170 (15.3%) in the historical comparison group, (OR 4.0 [2.08-7.7], p <0·0001).
Conclusions: Complex but treatable CAD is frequent in patients with refractory OOH VF/VT cardiac arrest. A systems approach using ECLS and reperfusion appeared to improve functionally favorable survival.