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Delivery of automatic electrical defibrillator (AED) by unmanned aerial vehicle (UAV) was suggested for out-of-hospital cardiac arrest (OHCA). The goal of this study is to assess the effect of topographic and weather conditions on call to AED attach time by UAV-AED. We included OHCA patients from 2013 to 2016 in Seoul, South Korea. We developed a UAV-AED flight simulator using topographic information of Seoul for Euclidean and topographic flight pathway including vertical flight to overcome high-rise structures. We used 4 kinds of UAV flight scenarios according to weather conditions or visibility. Primary outcome was emergency medical service (EMS) call to AED attach time. Secondary outcome was pre-arrival rate of UAV-AED before current EMS based AED delivery. Call to AED attach time in topographic pathway was 7.0 min in flight and control advanced UAV and 8.0 min in basic UAV model. Pre-arrival rate in Euclidean pathway was 38.0% and 16.3% for flight and control advanced UAV and basic UAV. Pre-arrival rate in the topographic pathway was 27.0% and 11.7%, respectively. UAV-AED topographic flight took longer call to AED attach time than Euclidean pathway. Pre-arrival rate of flight and control advanced UAV was decreased in topographic flight pathway compared to Euclidean pathway., (© 2021. The Author(s).)

Aim: There is no specific evidence on the antithrombotic management of survivors of out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI). We sought to compare the short-term outcome of unfractioned heparin (UFH) vs fondaparinux in OHCA survivors due to AMI admitted in our Institution in the last decade., Methods: We performed a retrospective cohort study on survivors of OHCA due to AMI managed with UFH or fondaparinux during the hospitalization. The primary outcome was the occurrence of any bleeding, all-cause mortality, cerebrovascular accidents, re-MI, and unplanned revascularization at 1 month. A propensity-score matching was performed to compare the outcome between UFH and fondaparinux., Results: Out of 2083 AMI patients undergoing successful PCI, OHCA was present in 94 (4.5%): 41 (43.6%) treated with UFH and 53 (56.4%) with fondaparinux. At clinical follow-up, the incidence of the primary outcome was 65.9% in UFH and 35.8% in fondaparinux group (p = 0.007). More than half of the events included in the primary outcome were related to bleeding complications. In the matched cohort of 56 patients, the primary outcome occurred in 46.4% and 25.0% (p = 0.16), while bleeding was present in 32.1% and 7.1% (p = 0.04), in the UFH and fondaparinux group, respectively., Conclusions: The present analysis suggests that fondaparinux is safer than UFH in the management of OHCA due to AMI by reducing early bleeding complications at one month., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Early mechanical circulatory support with Impella may improve survival outcomes in the setting of postcardiac arrest cardiogenic shock after out-of-hospital cardiac arrest complicating acute myocardial infarction. However, the optimal timing to initiate mechanical circulatory support in this particular setting remains unclear. Therefore, we aimed to compare survival outcomes of patients supported with Impella 2.5 before percutaneous coronary intervention (pre-PCI) with those supported after percutaneous coronary intervention (post-PCI)., Design: Retrospective single-center study between September 2014 and December 2019 admitted to the Cardiac Arrest Center in Marburg, Germany., Patients: Out of 2,105 patients resuscitated from out-of-hospital cardiac arrest due to acute myocardial infarction with postcardiac arrest cardiogenic shock between September 2014 and December 2019 and admitted to our regional cardiac arrest center, 81 consecutive patients receiving Impella 2.5 during admission coronary angiogram were identified., Outcomes/measurements: Survival outcomes were compared between those with Impella support pre-PCI to those with support post-PCI., Main Results: A total of 81 consecutive patients with infarct-related postcardiac arrest shock supported with Impella 2.5 during admission coronary angiogram were included. All patients were in profound cardiogenic shock requiring catecholamines at admission. Overall survival to discharge and at 6 months was 40.7% and 38.3%, respectively. Patients in the pre-PCI group had a higher survival to discharge and at 6 months as compared to patients of the post-PCI group (54.3% vs 30.4%; p = 0.04 and 51.4% vs 28.2%; p = 0.04, respectively). Furthermore, the patients in the early support group demonstrated a greater functional recovery of the left ventricle and a better restoration of the end-organ function when Impella support was initiated prior to percutaneous coronary intervention., Conclusions: Our results suggest that the early initiation of mechanical circulatory support with Impella 2.5 prior to percutaneous coronary intervention is associated with improved hospital and 6-month survival in patients with postcardiac arrest cardiogenic shock complicating acute myocardial infarction., Competing Interests: Drs. Schieffer, Karatolios, Markus and Luesebrink have received speaker’s honoraria from Abiomed. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Specific measures using a Six Sigma approach led to sustained reduction of door-to-balloon times among patients with ST-segment elevation myocardial infarction (STEMI) in a community setting.

Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151)., Methods: Resuscitated bystander witnessed OHCA patients >18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded., Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days., Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aims: The aim of this study was to investigate the effect of contact-to-balloon time on mortality in ST-segment elevation myocardial infarction (STEMI) patients with and without haemodynamic instability., Methods and Results: Using data from the prospective, multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial, we assessed the prognostic relevance of first medical contact-to-balloon time in n = 12 675 STEMI patients who used emergency medical service transportation and were treated with primary percutaneous coronary intervention (PCI). Patients were stratified by cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA). For patients treated within 60 to 180 min from the first medical contact, we found a nearly linear relationship between contact-to-balloon times and mortality in all four STEMI groups. In CS patients with no OHCA, every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated patients. This treatment delay-related increase in mortality was significantly higher as compared to the two groups of OHCA patients with shock (2.09) and without shock (1.34), as well as to haemodynamically stable patients (0.34, P < 0.0001)., Conclusions: In patients with CS, the time elapsing from the first medical contact to primary PCI is a strong predictor of an adverse outcome. This patient group benefitted most from immediate PCI treatment, hence special efforts to shorten contact-to-balloon time should be applied in particular to these high-risk STEMI patients., Clinical Trial Registration: NCT00794001.

Electrocardiogram (ECG) as one of the best methods to measure irregular heartbeats is a dispensable method for doctor to diagnose Acute Myocardial Infarction (AMI) patients. Most medical centers in Taiwan implement the reduction of Door to Balloon (D2B) time, which is defined as the time interval starting when an Acute-Myocardial-Infarction patient arrives at the Emergency Department, and ending when a catheter guide wire crosses the culprit lesion as the acute-myocardial-infarction treatment on the patient in the cardiac catheterization room. Generally, when a patient with acute-chest pain is sent into a hospital (always to Emergency Department), the hospital will collect his/her ECG which needs to be evaluated by a cardiologist to ensure that the patient really has Acute Myocardial Infarction. Then the medical workers deliver the patient to the cardiac catheterization room to operate balloon angioplasty. In previous years, the cardiologist must utilize a PC to connect to the Intranet of the hospital and employ a special PACS (Picture Archiving and Communication System) image browser before he/she can check the patient's ECG. But this will prolong the D2B time since the doctor may stay outdoors and he/she needs some time to find a PC and network. Of course, if the PC has not installed the PACS image browser, the doctor has to download and install it. Consequently, the D2B time should be worsened, thus possibly impacting the patient's life. Therefore, in this paper, we introduce a Cloud-based Electrocardiogram System, with which cardiologists can directly utilize their smart phones to browse the patient's ECG so as to shorten the D2B time. This system has been online in a medical center in middle Taiwan for more than one year. The shortened D2B time is longer than 10 min, i.e., receiving fine results.

Introduction: Emergency department thoracotomy is an established procedure for cardiac arrest in patients suffering from penetrating thoracic trauma and yields relatively high survival rates (up to 21%) in patients with cardiac tamponade. To minimize the delay between arrest and thoracotomy, some have advocated thoracotomy on the accident scene. The aim of this study was to determine the proportion of patients with return of spontaneous circulation and subsequent survival after out of hospital thoracotomy in the Netherlands., Methods: A retrospective analysis of data collected on all out of hospital thoracotomies performed in the Netherlands after penetrating trauma between April 1st, 2011 and September 30th, 2016 was performed. Data on patient characteristics, trauma mechanism and outcome were collected and analyzed. Primary outcome measure was return of spontaneous circulation after the intervention. Survival to hospital discharge was the secondary outcome variable., Results: Thirty-three prehospital emergency thoracotomies were performed. Ten patients (30%) had gunshot wounds and 23 patients (70%) had stab wounds. Nine patients (27%) had return of spontaneous circulation and were presented to the hospital. Of these, one patient survived until discharge without neurological damage. Five died in the emergency department or operating room and three died in ICU., Conclusion: Return of spontaneous circulation after out of hospital thoracotomy for cardiac arrest due to penetrating thoracic injury is achievable, but a substantial number of patients die during the in hospital resuscitation phase. However, neurologic intact survival can be achieved., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Survival rates and outcomes after out-of-hospital cardiac arrest (OHCA) remain low despite investments of time and money. The goal of this analysis was to identify variables related to survival of patients transferred to our coronary care unit (CCU) after an OHCA., Methods: 102 consecutive OHCA patients, mean age 64.6 (SD 13.3), 70.6% men, between January, 2011 and December, 2013, who were transferred to our tertiary care CCU, were studied., Results: Cardiac-cause OHCA was present in 84 patients (82.4%). Of these 60.7% had an acute coronary syndrome (ACS) - STEMI 35.7%; NSTEMI 23.8%. Coronary angiography was performed in 73 (71.6%) patients - 81% with cardiac- and 31.3% (5/16) with a non-cardiac cause. Percutaneous coronary intervention (PCI) was performed in 50 patients (68.5%), 49 with cardiac-cause, and succeeded in 92%. In-hospital mortality was 38.2%, one-year mortality was 51.5%. In-hospital and one-year mortality were related to age (p=0.002 resp. p=0.001), first ECG rhythm (p=0.001, resp. p=0.005), history of coronary artery disease (RR 2.1; p=0.026 resp. RR 1.71; p=0.029), and history of arrhythmia (supraventricular tachyarrhythmia, bradyarrhythmia) (RR 2.74; p=0.003 resp. RR 2.3; p=0.001). One-year mortality was also related to a history of diabetes mellitus (RR 1.89; p=0.006)., Conclusion: Cardiac-cause was the most common cause of OHCA. Acute coronary syndrome was present in more than half of the cases. Availability of interventional facilities was a crucial factor in OHCA management. A history of coronary artery disease, diabetes mellitus, and arrhythmia were associated with worse survival., (Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Survivors of out-of-hospital cardiac arrest (OHCA) have high mortality and morbidity. An acute coronary event is the most common cause of sudden cardiac death. For this reason, coronary angiography is an important diagnostic and treatment strategy for patients with postcardiac arrest. This study aimed to identify the correlation between postreturn of spontaneous circulation (ROSC) on an electrocardiogram (ECG) and results of coronary angiography of OHCA survivors.We collected data from our OHCA registry from January 2010 to November 2014. We categorized OHCA survivors into 2 groups according to post-ROSC ECG results. Emergent coronary artery angiography (CAG) (CAG performed within 12 hours after cardiac arrest) was performed in patients who showed ST segment elevation or new onset of left bundle branch block (LBBB) in post-ROSC ECG. For other patients, the decision for performing CAG was made according to agreement between the emergency physician and the cardiologist.During the study period, 472 OHCA victims visited our emergency department and underwent cardiopulmonary resuscitation. Among 198 OHCA survivors, 82 patients underwent coronary artery intervention. Thirty-one (70.4%) patients in the ST segment elevation or LBBB group and 10 (24.4%) patients in the nonspecific ECG group had coronary artery lesions (P < .01). Seven (18.4%) patients in the nonspecific ECG group showed coronary spasm.OHCA survivors without ST segment elevation or new onset LBBB still have significant coronary lesions in CAG. If there is no other obvious arrest cause in patients without significant changes in post ROSC ECG, CAG should be considered to rule out the possibility of coronary artery problems, including coronary spasm.

Introduction: The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some Emergency Medical Service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination., Objective: To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC. Lastly, to compare the impact of time to ROSC as a marker of futility to the Universal TOR Guideline., Design: Retrospective, observational cohort study., Participants: Non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS providers., Setting: ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011., Outcomes: Primary outcome was survival to hospital discharge and the secondary outcome was functional survival. We used multivariable regression to evaluate factors associated with survival in patients transported without a ROSC., Results: 36,543 treated OHCAs occurred of which 9467 (26%) were transported to hospital without a ROSC. Patients transported without a ROSC who met the Universal TOR Guideline for transport had a survival of 3.0% (95% CI 2.5-3.4%) compared to 0.7% (95% CI 0.4-0.9%) in patients who met the Universal TOR Guideline for termination. The Universal TOR Guideline identified 99% of survivors requiring continued resuscitation and transportation to hospital including early identification of survivors who sustained a ROSC after extended durations of CPR., Conclusion: Using absence of ROSC as a sole predictor of futility misses potential survivors. The Universal TOR Guideline remains a strong predictor of survival., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the writing and content of the paper., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Despite advances in cardiopulmonary resuscitation, functional survival remains low after out-of-hospital cardiac arrest (OOHCA). Intra-aortic balloon pump (IABP) therapy has recently been shown to augment cerebral blood flow. Whether IABP therapy in the post-resuscitation period improves functional outcomes is unknown., Methods: We analysed 174 consecutive patients who were successfully resuscitated from an OOHCA between 2011-2013 at Harefield Hospital, London. We analysed functional status at discharge and mortality up to one year., Results: A total of 55 patients (32.1%) received IABP therapy. Comparing those receiving IABP with those not receiving IABP, there was no difference in favourable functional status at discharge (49.1% vs. 57.1%, p=0.321); and mortality at one year (45.5% vs. 35.5%, p=0.164). Multivariable analyses identified IABP therapy as a strong independent predictor for favourable functional status at discharge (OR=7.51, 95% CI: 2.15-26.14, p=0.002) and this association was maintained in propensity-score adjusted analyses (OR=9.90, 95% CI: 2.11-46.33, p=0.004) and inverse probability treatment weighted analyses (OR=10.84, 95% CI: 2.75-42.69, p<0.001). However, IABP therapy was not an independent predictor for mortality at one year (HR=0.93, 95% CI: 0.52-1.65, p=0.810) and this was confirmed in both propensity-score adjusted and inverse probability treatment weighted analyses., Conclusions: In this observational analysis of patients surviving an OOHCA, the use of IABP therapy in the post-resuscitation period was associated with improved functional outcomes. This warrants further evaluation in larger prospective studies., (Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Out-of-Hospital refractory Cardiac Arrest (OHrCA) has a mortality rate between 90 and 95%. Since 2009, French medical academic societies have recommended the use of extracorporeal life support (ECLS) for OHrCA. According to these guidelines, patients were eligible for ECLS support if vital signs were still present during cardiopulmonary resuscitation (CPR), or if cardiac arrest was secondary to intoxication or hypothermia (≤32°C). Otherwise, patients would receive ECLS if (i) no-flow duration was less than 5 min; (ii) time delays from CPR to ECLS start (low flow) were less than 100 min; and (iii) expiratory end tidal CO2 (ETCO2 ) was more than 10 mm Hg 20 min after initiating CPR. We have reported here our experience with ECLS in OHrCA according to the previous guidelines. We retrospectively analyzed mortality rates of patients supported with ECLS in case of OHrCA. From December 2009 to December 2013, 183 patients were assisted with ECLS, among which 32 cases were of OHrCA. Mean age for the OHrCA patients was 43.6 years. Over two-thirds were male (71.9%). Causes of OHrCA included intoxication, isolated hypothermia <32°C, acute coronary syndrome, pulmonary edema, and other cardiac pathology. Despite adherence to protocols, only two patients (6.2%) with hypothermia and acute myocardium ischemia, respectively, could be discharged from hospital after cardiac recovery. Causes of death were brain death and multiple organ failure. Despite ECLS support setting in accordance with French guidelines in case of refractory OHrCA, mortality rates remained high. French ECLS support recommendations for OHrCA due to presumed cardiac cause should be re-examined through new studies. Low flow duration should be improved by a shorter time of CPR before hospital transfer., (© 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Background: Major bleeding is a serious complication of percutaneous coronary intervention (PCI). We set out to investigate the incidence of major bleeding and its impact on hospitalisation and long-term mortality., Method: We examined seven years of registry data encompassing 16,860 PCI procedures., Results: Between 2005 and 2011 major bleeding increased from 1.3% to 3.4%. In patients with ST elevated myocardial infarction (STEMI), the rate increased from 2.3% to 6.4%. The increase remained significant after adjusting for patient and procedural characteristics (OR=1.09/year, p=0.001). Bleeding risk was highest in patients presenting with out-of-hospital cardiac arrest and cardiogenic shock (CS). Women, STEMI patients, those aged over 70yrs or weighing <60kg were at higher risk. Glycoprotein IIb/IIIa-inhibitor use more than doubled the risk of bleeding (OR=2.28, p=<0.001). Mortality rates at one year were 4.18% overall and 7.9% in STEMI. Bleeding was a strong predictor of mortality after adjusting for potential confounders (HR=2.92, 95% CI: 2.08, 4.09). Bleeding significantly increased length of stay (med four days vs seven days) and rehospitalisation at 12 months (OR=1.36, 95% CI: 1.08, 1.70)., Conclusions: Major bleeding rates post-PCI appear to be increasing in Australia. Bleeding increases hospitalisation and is associated with poor clinical outcomes., (Copyright © 2015. Published by Elsevier B.V.)

We report the case of a 13-day-old infant with enteroviral myocarditis surviving an out-of-hospital cardiac arrest. She underwent orthotopic cardiac transplantation three months later. A year after the transplantation, she is alive and well. Enteroviral infection is common in neonates with high mortality in cases of enteroviral myocarditis. Cardiac transplantation is a treatment option for infants who fail to recover and remain dependent on inotropic support. This is the first report of an infant with out-of-hospital cardiac arrest secondary to enteroviral myocarditis surviving up to cardiac transplantation.

Background: It is unclear whether the benefits of post-resuscitative percutaneous coronary intervention (PCI) are equally observed across out-of-hospital cardiac arrests (OHCAs) with different clinical presentations. The purpose of this study was to assess the effect of PCI in outcomes of OHCA and to compare patient prognosis by history of heart disease (HD) and presentations of nonshockable vs. shockable arrest rhythm by electrocardiogram (ECG)., Methods: A population-based observational study was conducted on OHCAs of cardiac etiology in Korea who survived to admission between 2009 and 2013. Multivariable logistic regression analyses were conducted to assess the associations between PCI and outcomes (favorable neurological outcome and survival-to-discharge) and to test the interaction effects of PCI with history of HD and with presence of shockable rhythm., Results: A total of 9762 OHCAs were analyzed. PCI was done in 1140 (11.7%), and neurological recovery were observed in 45.7% of the PCI group and 13.3% of the untreated group. Effects of PCI on neurological recovery were observed similarly in patients with and without history of HD (OR=2.33 (1.62-3.35) and OR=2.37 (1.95-2.89), respectively). PCI was associated with survival-to-discharge only in patients without history of HD (OR=1.80 (1.51-2.15)). PCI was associated with neurological recovery and survival-to-discharge in both shockable and nonshockable rhythms, although the estimates were relatively higher in those with nonshockable rhythms (OR for neurological recovery=2.60 (2.04-3.32); and OR for survival=1.78 (1.46-2.17))., Conclusions: This study corroborates that PCI is an advantageous treatment option for all patients with OHCA regardless of established diagnosis with HD and presentations of shockable rhythm., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Current recommendations are for primary percutaneous coronary intervention (pPCI) in ST-elevation myocardial infarction (STEMI) complicated by out of hospital cardiac arrest (OHCA). However, information about longer-term outcomes is sparse, particularly among high-risk patients who do not regain consciousness promptly after resuscitation., Methods and Results: Of 1836 consecutive patients admitted with STEMI for pPCI between April 2008-October 2011, 132 (7.2%) who had suffered OHCA with recovery of spontaneous circulation (ROSC) form the study population. 101 patients survived to hospital discharge (76.5%) with only one further death in the first year. Prognosis was worse for the 62 patients who were unconscious on arrival and required admission to the intensive therapy unit (ITU), only 54% of whom survived. Every additional minute in the time to ROSC increased the hazard of death by 1.7% while alertness upon ROSC and successful reperfusion in response to pPCI reduced the hazard of death by 90% and 65% respectively. Full neurological recovery was recorded in 85.1% of those who survived to be discharged but in only 30.6% of the 34 survivors who were admitted unconscious and received ITU treatment. Every additional minute in the time to ROSC increased the odds of neurological deficit by 7.0%., Conclusions: In patients with STEMI who are conscious after OHCA, high rates of survival can be achieved with pPCI, depending in part on the time it takes for ROSC. Prognosis is less good in the subgroup brought to hospital unconscious but even in this high risk group neurologically intact survival can be achieved in about one-third of cases, suggesting the benefit of immediate pPCI in STEMI patients successfully resuscitated after OHCA., (© The European Society of Cardiology 2014.)

Objectives and Background: Despite a generally broad use of vascular closure devices (VCDs), it remains unclear whether they can also be used in victims from out-of-hospital cardiac arrest (OHCA) treated with mild therapeutic hypothermia (MTH)., Methods: All victims from OHCA who received immediate coronary angiography after OHCA between January 1(st) 2008 and December 31(st) 2013 were included in this study. The operator decided to either use a VCD (Angio-Seal™) or manual compression for femoral artery puncture. The decision to induce MTH was based on the clinical circumstances., Results: 76 patients were included in this study, 46 (60.5%) men and 30 (39.5%) women with a mean age of 64.2 ± 12.8 years. VCDs were used in 26 patients (34.2%), and 48 patients (63.2%) were treated with MTH. While there were significantly more overall vascular complications in the group of patients treated with MTH (12.5% versus 0.0%; p=0.05), vascular complications were similar between patients with VCD or manual compression, regardless of whether or not they were treated with MTH., Conclusion: In our study, the overall rate of vascular complications related to coronary angiography was higher in patients treated with mild therapeutic hypothermia, but was not affected by the application of a vascular closure device. Therefore, our data suggest that the use of VCDs in victims from OHCA might be feasible and safe in patients treated with MTH as well, at least if the decision to use them is individually carefully determined.

This case illustrates the potential clinical usefulness of retrograde approach for selective visualization of distal vessels in a patient with multiple coronary chronic total occlusions and previous coronary artery bypass graft (CABG) surgery. By knowing in extreme detail the exact anatomy of the complex post-surgical coronary system, a successful treatment can be planned for the patient., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: We sought to evaluate the clinical outcomes of patients with myocardial infarction (MI) complicated by out-of-hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI)., Background: Controversy remains regarding the benefit of early PCI in patients with MI complicated by OHCA., Methods: We analyzed the outcomes of 88 consecutive patients presenting with MI complicated by OHCA compared to 5101 patients with MI without OHCA who underwent PCI from the Melbourne Interventional Group registry between 2004 and 2009., Results: Patients with OHCA had a higher proportion of ST-elevation MI presentations (90.9% vs. 50%, p<0.01) and were more likely to be to be in cardiogenic shock (38.6% vs. 4.6%, p<0.01). Procedural success was similar in the two groups (95.5% OHCA vs. 96.5% non-OHCA MI cohort, p=0.65). In-hospital, 30-day, and 1-year survival in the OHCA cohort versus the non-OHCA MI cohort were 62.5% vs. 97.2% (p<0.01), 61.4% vs. 96.5% (p<0.01), and 60.2% vs. 94.2% (p<0.01), respectively. Within the OHCA cohort, presentation with cardiogenic shock (OR 7.2, 95% CI: 2.7-18.8; p<0.01) was strongly associated with in-hospital mortality. Importantly, 1-year survival of patients discharged alive from hospital was similar between the two groups (96% vs. 97% p=0.8)., Conclusion: Patients with MI complicated by OHCA remain a high-risk group associated with high mortality. However, high procedural success rates similar to non-OHCA patients can be attained. Survival rates better than previously reported were observed with an emergent PCI approach, with 1-year survival comparable to a non-OHCA cohort if patients survive to hospital discharge., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Implementation barriers for extracorporeal life support in out-of-hospital cardiac arrest (OHCA) include initiation delay and candidate selection. We explored ischemia duration, cardiopulmonary resuscitation (CPR) duration, and physiologic variables that discriminated animals with return of spontaneous circulation (ROSC). We instrumented eight female swine (31.9 +/- 9.8 kg) with femoral artery and external jugular vein cannula. After 8 (n = 4) or 15 (n = 4) minutes ventricular fibrillation (VF), animals received 30, 40, 50, or 60 minutes of CPR and then drugs (.6 U/kg vasopressin, .1 mg/kg epinephrine, .1 mg/kg propranolol, sodium bicarbonate as indicated) after 5 minutes of CPR. Extracorporeal membrane oxygenation (ECMO) flow rate was 3 L/min < or =2 hours and then 1.5 L/min < or =2 hours before weaning. Animals were defibrillated (150 J biphasic) > or =15 minutes ECMO. Primary outcome for successful resuscitation was ROSC (organized rhythm with systolic blood pressure >80 mmHg). We measured arterial blood gas, electrolytes, mean arterial pressure (MAP), coronary perfusion pressure (CPP), and five quantitative VF waveform measures at key intervals. Continuous variables were compared with two-sample t test. All 8-minute VF animals were successfully resuscitated and had ROSC. MAP was higher at the beginning (27.0 +/- 7.1 vs. 15.0 +/- 4.4; p = .03) and end (31.3 +/- 12.8 vs. 11.5 +/- 7.3; p = .03) of CPR in animals successfully resuscitated. CPP was higher at the beginning of CPR (11.9 +/- 4.6 vs. 3.3 +/- 2.2;p = .01) and the end of CPR (18.5 + 12.1 vs..9 +/- 1.4; p = .03) among animals with ROSC. Amplitude spectrum area (AMSA) was superior at the end of CPR (-2.0 +/- 1.8 vs. -5.0 +/- 1.4; p = .04) in animals successfully resuscitated. In a porcine OHCA model, MAP and CPP at the beginning and end of CPR were higher in animals successfully resuscitated. AMSA was superior at the end of CPR in animals successfully resuscitated.

Purpose of Review: The role of cardiac arrest centers, more recently termed Cardiac Receiving Centers, in improving outcomes after successful resuscitation is becoming more and more convincing. But which of all the treatments provided by Cardiac Receiving Centers are most beneficial is less certain. This review examines the role of early coronary angiography and percutaneous coronary intervention in this regard., Recent Findings: Cohort studies have consistently found that early coronary angiography is associated with improved long-term outcomes postcardiac arrest. The most common cause for out-of-hospital cardiac arrest is a myocardial ischemic event. Diagnosing and treating the underlying coronary trigger makes good physiological sense. The major issues are 'who' should undergo emergent coronary angiography and 'when' should it be done. Standard criteria such as ST segment elevation and precedent chest pains are not very sensitive in identifying those postcardiac arrest with an occluded or culprit lesion. As many as one in four postresuscitated patients without ST elevation have a significant culprit lesion, including at times an acutely occluded coronary. Cardiac Receiving Centers should have the capacity to perform emergent coronary angiography on every resuscitated patient who does not have an obvious noncardiac cause for their arrest., Summary: Emergent coronary angiography and percutaneous coronary intervention are the most important Cardiac Receiving Center treatments beyond hypothermia. Providing both of these essential postresuscitation therapies is the very purpose of such centers.