Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
J Am Coll Cardiol. 2017 Aug 29;70(9):1109-1117. doi: 10.1016/j.jacc.2017.06.059.
The prevalence of coronary artery disease (CAD) among patients with refractory out-of-hospital (OH) ventricular fibrillation (VF)/ventricular tachycardia (VT) cardiac arrest is unknown.
The goal of this study was to describe the prevalence and complexity of CAD and report survival to hospital discharge in patients experiencing refractory VF/VT cardiac arrest treated with a novel protocol of early transport to a cardiac catheterization laboratory (CCL) for extracorporeal life support (ECLS) and revascularization.
Between December 1, 2015, and December 1, 2016, consecutive adult patients with refractory OH VF/VT cardiac arrest requiring ongoing cardiopulmonary resuscitation were transported by emergency medical services to the CCL. ECLS, coronary angiography, and percutaneous coronary intervention were performed, as appropriate. Functionally favorable survival to hospital discharge (Cerebral Performance Category 1 or 2) was determined. Outcomes in a historical comparison group were also evaluated.
Sixty-two (86%) of 72 transported patients met emergency medical services transport criteria. Fifty-five (89%) of the 62 patients met criteria for continuing resuscitation on CCL arrival; 5 had return of spontaneous circulation, 50 received ECLS, and all 55 received coronary angiography. Forty-six (84%) of 55 patients had significant CAD, 35 (64%) of 55 had acute thrombotic lesions, and 46 (84%) of 55 had percutaneous coronary intervention with 2.7 ± 2.0 stents deployed per patient. The mean SYNTAX score was 29.4 ± 13.9. Twenty-six (42%) of 62 patients were discharged alive with Cerebral Performance Category 1 or 2 versus 26 (15.3%) of 170 in the historical comparison group (odds ratio: 4.0; 95% confidence interval: 2.08 to 7.7; p < 0.0001).
Complex but treatable CAD was prevalent in patients with refractory OH VF/VT cardiac arrest who also met criteria for continuing resuscitation in the CCL. A systems approach using ECLS and reperfusion seemed to improve functionally favorable survival.
患有难治性院外（OH）心室颤动（VF）/室性心动过速（VT）心脏骤停的患者中冠状动脉疾病（CAD）的患病率尚不清楚。
本研究的目的是描述 CAD 的患病率和复杂性，并报告接受新型早期转运至心脏导管室（CCL）进行体外生命支持（ECLS）和血运重建的难治性 VF/VT 心脏骤停患者的存活至出院情况。
在 2015 年 12 月 1 日至 2016 年 12 月 1 日期间，连续收治需要持续心肺复苏的难治性 OH VF/VT 心脏骤停的成年患者，由急救医疗服务人员转运至 CCL。视情况进行 ECLS、冠状动脉造影和经皮冠状动脉介入治疗。确定存活至出院时功能良好（Cerebral Performance Category 1 或 2）。还评估了历史比较组的结果。
72 名转运患者中有 62 名（86%）符合急救医疗服务转运标准。62 名患者中，有 55 名（89%）符合 CCL 到达时继续复苏的标准；5 名患者出现自主循环恢复，50 名患者接受 ECLS，所有 55 名患者均接受冠状动脉造影。55 名患者中有 46 名（84%）有明显的 CAD，55 名中有 35 名（64%）有急性血栓性病变，55 名中有 46 名（84%）进行了经皮冠状动脉介入治疗，每位患者植入 2.7±2.0 个支架。平均 SYNTAX 评分 29.4±13.9。62 名患者中有 26 名（42%）出院时存活，Cerebral Performance Category 1 或 2，而历史比较组中有 170 名患者中的 26 名（15.3%）（比值比：4.0；95%置信区间：2.08 至 7.7；p<0.0001）。
在符合 CCL 继续复苏标准的难治性 OH VF/VT 心脏骤停患者中，存在复杂但可治疗的 CAD。使用 ECLS 和再灌注的系统方法似乎提高了功能良好的存活率。
