TY - JOUR
T1 - Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest
AU - Nas, J.
AU - Thannhauser, J.
AU - Dijk, E.G.J.A. van
AU - Verkroost, C.
AU - Damman, P.
AU - Wely, M. van
AU - Geuns, R.J. van
AU - Royen, N. van
AU - Boer, M.J. de
AU - Bonnes, J.L.
AU - Cate, T. ten
AU - Brouwer, M.A.
N1 - Funding Information:
Niels van Royen received research grants from Abbott , Biotronik , AstraZeneca and Philips , and professional fees from Abbott, Microport , Amgen and Medtronic . Peter Damman has received consultancy fees from Philips and Abbott, and research grants from Philips and AstraZeneca. Marleen van Wely has received proctor fees from Zoll Medical . The other authors have no conflicts of interest to declare.
Funding Information:
Niels van Royen received research grants from Abbott, Biotronik, AstraZeneca and Philips, and professional fees from Abbott, Microport, Amgen and Medtronic. Peter Damman has received consultancy fees from Philips and Abbott, and research grants from Philips and AstraZeneca. Marleen van Wely has received proctor fees from Zoll Medical. The other authors have no conflicts of interest to declare
Publisher Copyright:
© 2021 The Authors
PY - 2021/7
Y1 - 2021/7
N2 - Introduction: Shock-resistant ventricular fibrillation (VF) poses a therapeutic challenge during out-of-hospital cardiac arrest (OHCA). For these patients, new treatment strategies are under active investigation, yet underlying trigger(s) and substrate(s) have been poorly characterised, and evidence on coronary angiography (CAG) data is often limited to studies without a control group. Methods: In our OHCA-registry, we studied CAG-findings in OHCA-patients with VF who underwent CAG after hospital arrival. We compared baseline demographics, arrest characteristics, CAG-findings and outcomes between patients with VF that was shock-resistant (defined as >3 shocks) or not shock-resistant (≤3 shocks). Results: Baseline demographics, arrest location, bystander resuscitation and AED-use did not differ between 105 patients with and 196 patients without shock-resistant VF. Shock-resistant VF-patients required more shocks, with higher proportions endotracheal intubation, mechanical CPR, amiodaron and epinephrine. In both groups, significant coronary artery disease (≥1 stenosis >70%) was highly prevalent (78% vs. 77%, p = 0.76). Acute coronary occlusions (ACOs) were more prevalent in shock-resistant VF-patients (41% vs. 26%, p = 0.006). Chronic total occlusions did not differ between groups (29% vs. 33%, p = 0.47). There was an association between increasing numbers of shocks and a higher likelihood of ACO. Shock-resistant VF-patients had lower proportions 24-h survival (75% vs. 93%, p < 0.001) and survival to discharge (61% vs. 78%, p = 0.002). Conclusion: In this cohort of OHCA-patients with VF and CAG after transport, acute coronary occlusions were more prevalent in patients with shock-resistant VF compared to VF that was not shock-resistant, and their clinical outcome was worse. Confirmative studies are warranted for this potentially reversible therapeutic target.
AB - Introduction: Shock-resistant ventricular fibrillation (VF) poses a therapeutic challenge during out-of-hospital cardiac arrest (OHCA). For these patients, new treatment strategies are under active investigation, yet underlying trigger(s) and substrate(s) have been poorly characterised, and evidence on coronary angiography (CAG) data is often limited to studies without a control group. Methods: In our OHCA-registry, we studied CAG-findings in OHCA-patients with VF who underwent CAG after hospital arrival. We compared baseline demographics, arrest characteristics, CAG-findings and outcomes between patients with VF that was shock-resistant (defined as >3 shocks) or not shock-resistant (≤3 shocks). Results: Baseline demographics, arrest location, bystander resuscitation and AED-use did not differ between 105 patients with and 196 patients without shock-resistant VF. Shock-resistant VF-patients required more shocks, with higher proportions endotracheal intubation, mechanical CPR, amiodaron and epinephrine. In both groups, significant coronary artery disease (≥1 stenosis >70%) was highly prevalent (78% vs. 77%, p = 0.76). Acute coronary occlusions (ACOs) were more prevalent in shock-resistant VF-patients (41% vs. 26%, p = 0.006). Chronic total occlusions did not differ between groups (29% vs. 33%, p = 0.47). There was an association between increasing numbers of shocks and a higher likelihood of ACO. Shock-resistant VF-patients had lower proportions 24-h survival (75% vs. 93%, p < 0.001) and survival to discharge (61% vs. 78%, p = 0.002). Conclusion: In this cohort of OHCA-patients with VF and CAG after transport, acute coronary occlusions were more prevalent in patients with shock-resistant VF compared to VF that was not shock-resistant, and their clinical outcome was worse. Confirmative studies are warranted for this potentially reversible therapeutic target.
U2 - 10.1016/j.resuscitation.2021.05.006
DO - 10.1016/j.resuscitation.2021.05.006
M3 - Article
SN - 0300-9572
VL - 164
SP - 54
EP - 61
JO - Resuscitation
JF - Resuscitation
ER -
