Abstract 14267: Clinical Characteristics of Patients with Out-of-hospital Cardiac Arrest Caused by Ventricular Fibrillation Due to Acute Coronary Syndromes Who Responded to Extracorporeal Cardiopulmonary Resuscitation

Background: Extracorporeal cardiopulmonary resuscitation (ECRP) have been reported to be effective in patients with out-of-hospital cardiac arrest (OHCA) associated with an initial rhythm of ventricular fibrillation (VF) caused by acute coronary syndromes (ACS) refractory to conventional cardiopulmonary resuscitation (CPR). However, the clinical characteristics of patients who best respond to ECRP remain unclear. Methods: Between 2008 and 2012, we prospectively collected Utstein-style data at 46 institutions on 454 consecutive patients with OHCA aged 20 to 74 years had an initial rhythm of VF and arrived at the hospital within 45 minutes after the onset of cardiac arrest. They did not respond to conventional CPR given for more than 15 minutes after hospital arrival and received combination therapy with ECPR, percutaneous coronary intervention (PCI), intra-aortic balloon pumping (IABP), and therapeutic hypothermia (TH). ACS was diagnosed on emergency coronary angiography or clinical course in 133 patients. These patients were classified according to whether neurologic outcomes at 6 months, i.e., good outcome group (cerebral performance category [CPC] = 1 to 2) or poor outcome group (CPC = 3 to 5). Demographic characteristics were compared between two groups. Results: Among the 133 ACS patients given ECPR, good neurologic outcomes at 6 months in 14 (11%) patients, but not in 119 (89%) patients. There were no significant differences of age, the rate of witnessed arrest, bystander CPR, TH and time from hospital arrival to PCPS start between the 2 groups. Good outcome group had a shorter time from cardiac arrest to hospital arrival (24.9± 8.6 vs. 29.5± 10.1 min, p=0.03) and time from cardiac arrest to PCPS start (44 ± 8.8 vs. 53.7 ± 15.9 min, p=0.01) than poor outcome group. Conclusions: Our results suggest that shortening the interval from cardiac arrest until PCPS start, especially until hospital arrival, may improve neurologic outcomes in patients with refractory VF caused by ACS.