Better outcome after cardiopulmonary resuscitation using percutaneous emergency circulatory support in non-coronary patients compared to myocardial infarctions

Objectives: Mobile heart-lung-machines offer hemodynamic stabilization in refractory circulatory arrest. These emergency devices can be applied by percutaneous cannulation of the femoral vessels. They are mostly used in patients suffering from acute myocardial infarction (AMI) when requiring hemodynamic stabilization for emergency revascularisation. Whether patients with non-coronary reasons of circulatory arrest also benefit of percutaneous emergency circulatory support (pECS) is still unclear.

Methods: We included 22 consecutive patients with circulatory arrest who were treated by pECS. The diameter of the arterial and the venous sheath was 17F and 19F, respectively. Study endpoint was 30-day mortality rate.

Results: Circulatory arrest was caused by AMI in 14 patients (64%). The remaining 8 patients suffered from cardiomyopathy/myocarditis (4), pulmonary embolism (2), acute pulmonary failure, and tumor lyses syndrome. Revascularisation rate was 93% in the AMI group under pECS support. We observed a 30-day survival rate of 62.5% among non-coronary patients, in contrast to only 21.4% in the AMI group (p=0.02). Overall 30-day survival rate was 36.4%. The mean age of non-coronary patients was 48 years (±15.9) compared to 59 years (±11.8) in the AMI group (p=0.04). Heart transplantation (2), left ventricular assist device (Thoratec, Impella (2)), or membrane oxygenator (Novalung) were associated with better outcome.

Conclusion: Mobile heart-lung-machines provide hemodynamic stabilization in emergency situations. One fifth of AMI patients can be saved when other means of resuscitation fail. Higher success rates can be achieved in non-coronary patients as a result of a close cooperation between cardiologists and cardiac surgeons.