BACKGROUND 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. OBJECTIVES 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.

中文翻译：

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院外难治性心室颤动心脏骤停患者的冠状动脉疾病

背景 难治性院外 (OH) 室颤 (VF)/室性心动过速 (VT) 心脏骤停患者中冠状动脉疾病 (CAD) 的患病率尚不清楚。目的 本研究的目的是描述 CAD 的患病率和复杂性，并报告在接受早期转运至心导管实验室 (CCL) 进行体外生命支持的新方案治疗的难治性 VF/VT 心脏骤停患者中，其出院存活率(ECLS) 和血运重建。方法 2015 年 12 月 1 日至 2016 年 12 月 1 日期间，需要持续心肺复苏的难治性 OH VF/VT 心脏骤停成年患者连续被紧急医疗服务运送到 CCL。进行了 ECLS、冠状动脉造影和经皮冠状动脉介入治疗，作为适当的。确定出院后功能良好的存活率（脑功能类别 1 或 2）。还评估了历史对照组的结果。结果 72 名转运患者中有 62 名 (86%) 符合紧急医疗服务转运标准。62 名患者中有 55 名 (89%) 符合 CCL 到达时继续复苏的标准；5 人自主循环恢复，50 人接受 ECLS，55 人均接受冠状动脉造影。55 名患者中有 46 名 (84%) 有显着 CAD，55 名中有 35 名 (64%) 有急性血栓性病变，55 名中有 46 名 (84%) 接受了经皮冠状动脉介入治疗，每位患者部署了 2.7 ± 2.0 个支架。平均 SYNTAX 得分为 29.4 ± 13.9。62 名患者中有 26 名 (42%) 以脑功能分类 1 或 2 级出院，而 26 名 (15. 3%）的历史比较组中的 170（优势比：4.0；95% 置信区间：2.08 至 7.7；p < 0.0001）。结论 复杂但可治疗的 CAD 在难治性 OH VF/VT 心脏骤停患者中普遍存在，这些患者也符合 CCL 中继续复苏的标准。使用 ECLS 和再灌注的系统方法似乎可以提高功能上有利的生存率。