1. Resuscitation. 2010 Apr;81(4):383-7. Epub 2009 Dec 14.

Cardiac arrest in the catheterisation laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Wagner H, Terkelsen CJ, Friberg H, Harnek J, Kern K, Lassen JF, Olivecrona GK. Department of Cardiology, Lund University Hospital, 221 85 Lund, Sweden. henrik.wagner@skane.se Comment in Resuscitation. 2010 Apr;81(4):371-2. PURPOSE: Lengthy resuscitations in the catheterisation laboratory carry extremely high rates of mortality because it is essentially impossible to perform effective chest compressions during percutaneous coronary intervention (PCI). The purpose of this study was to evaluate the use of a mechanical chest compression device, LUCAS, in the catheterisation laboratory, in patients who suffered circulatory arrest requiring prolonged resuscitation. MATERIALS AND METHODS: The study population was comprised of patients who arrived alive to the catheterisation laboratory and then required mechanical chest compression at some time during the angiogram, PCI or pericardiocentesis between 2004 and 2008 at the Lund University Hospital. This is a retrospective registry analysis. RESULTS: During the study period, a total of 3058 patients were treated with PCI for ST-elevation myocardial infarction (STEMI) of whom 118 were in cardiogenic shock and 81 required defibrillations. LUCAS was used in 43 patients (33 STEMI, 7 non-ST-elevation myocardial infarction (NSTEMI), 2 elective PCIs and 1 patient with tamponade). Five patients had tamponade due to myocardial rupture prior to PCI that was revealed at the start of the PCI, and all five died. Of the remaining 38 patients, 1 patient underwent a successful pericardiocentesis and 36 were treated with PCI. Eleven of these patients were discharged alive in good neurological condition. CONCLUSION: The use of mechanical chest compressions in the catheterisation laboratory allows for continued PCI or pericardiocentesis despite ongoing cardiac or circulatory arrest with artificially sustained circulation. It is unlikely

that few, if any, of the patients would have survived without the use of mechanical chest compressions in the catheterisation laboratory.

1. Coron Artery Dis. 2008 Dec;19(8):615-8. Outcome of emergency percutaneous coronary intervention for acute STelevation myocardial infarction complicated by cardiac arrest. Mager A, Kornowski R, Murninkas D, Vaknin-Assa H, Ukabi S, Brosh D, Battler A, Assali A. Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel. avivm@clalit.org.il BACKGROUND: The poor prognosis of primary percutaneous coronary intervention (PCI) in patients resuscitated from cardiac arrest complicating acute ST-segment elevation myocardial infarction (STEMI) may at least partly be explained by the common presence of cardiogenic shock. This study examined the impact of emergency primary PCI on outcome in patients with STEMI not complicated by cardiogenic shock who were resuscitated from cardiac arrest. METHODS AND RESULTS: The study group included 948 consecutive patients without cardiogenic shock who underwent emergency primary PCI from 2001 to 2006 for STEMI. Twenty-one of them were resuscitated from cardiac arrest before the intervention. Data on background, clinical characteristics, and outcome were prospectively collected. There were no differences between the resuscitated and nonresuscitated patients in age, sex, infarct location, or left ventricular function. The total one-month mortality rate was higher in the resuscitated patients (14.3 vs. 3.4%, P=0.033), but noncardiac mortality accounted for the entire difference (14.3 vs. 1.2%, P=0.001), whereas cardiac mortality was similarly low in the two groups (0 vs. 2.0%, P=NS). Predictors of poor outcome in the resuscitated patients were older age (r=0.47, P=0.032), unwitnessed sudden death (r=0.44, P=0.04), longer interval between onset of cardiac arrest and arrival of a mobile unit (r=0.67, P=0.001) or to spontaneous circulation (r=0.65, P=0.001), low glomerular filtration rate (r=-0.50, P=0.02), and the initial thrombolysis in myocardial infarction grade of flow (r=-0.51, P=0.017).

CONCLUSION: Emergency PCI for STEMI not associated with cardiogenic shock exerts a similar effect on cardiac mortality in patients who were resuscitated from cardiac arrest and in those without this complication. The higher allcause mortality rate among resuscitated patients is explained by noncardiac complications.

1. Curr Opin Crit Care. 2008 Jun;14(3):287-91. Urgent invasive coronary strategy in patients with sudden cardiac arrest. Noc M, Radsel P. Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia. marko.noc@mf.uni-lj.si PURPOSE OF REVIEW: To review the evidence on urgent coronary angiography and percutaneous coronary intervention after resuscitated cardiac arrest and during ongoing cardiocerebral resuscitation. RECENT FINDINGS: In almost 450 patients with acute ST-elevation myocardial infarction after reestablishment of spontaneous circulation, success rate of primary percutaneous coronary intervention was 89%. Survival rates in conscious patients after reestablishment of spontaneous circulation were comparable to patients without preceding cardiac arrest while in comatose patients, survival was 57% and survival with acceptable neurological outcome 38%. Nonrandomized trials in 106 comatose survivors of cardiac arrest indicate that urgent invasive coronary strategy can be safely combined with mild induced hypothermia. Percutaneous coronary intervention is also feasible in patients undergoing cardiocerebral resuscitation. In 34 reported patients, the success rate of percutaneous coronary intervention was 88% and survival to hospital discharge 41%. SUMMARY: Urgent coronary angiography and percutaneous coronary intervention should be attempted in conscious patients after reestablishment of spontaneous circulation similarly as in patients with acute coronary syndromes without preceding cardiac arrest. In comatose survivors, urgent coronary strategy is reasonable if acute ischemic cause is suspected and if there is realistic hope

for neurological recovery that should be facilitated with mild induced hypothermia. Urgent coronary invasive strategy may be successful also during ongoing resuscitation in selected patients without advanced heart diseases and significant comorbidities.