Coronary intervention on a moving target: a case report and procedural considerations.

Cardiac arrest carries a considerable mortality. Among survivors, the incidence of neurological dysfunction is considerable. Coronary disease is a major cause of cardiac arrest and early and effective resuscitation is related to outcome. We report for the first time a case of successful coronary angiography and primary percutaneous coronary intervention (PCI) during ongoing ventricular fibrillation (VF) supported by mechanical chest compressions following out-of-hospital ST-elevation myocardial infarction (STEMI) and VF cardiac arrest. It illustrates four novel findings permitted by the use of mechanical chest compressions: (1) that it provided a perfusion pressure that facilitated the act of coronary angiography during ongoing VF following out-of-hospital STEMI and VF arrest, which (2) in turn permitted successful primary PCI, with (3) maintained neurological function and survival despite 79 minutes between arrest and PCI, and (4) illustrates the practical considerations that one must consider for PCI during mechanical chest compressions.