Abstract
Target temperature management (TTM) improves neurological outcome in out-of-hospital cardiac arrest (OHCA) patients. TTM should be performed for OHCA patients as soon as possible. On the other hand, we also need to perform emergency coronary angiography and primary percutaneous coronary intervention (PCI) against ongoing myocardial ischemia for the patient after cardiac arrest of cardiac etiology. However, there have been few studies showing which therapy should be done first. We evaluate the priority of TTM or PCI after return of spontaneous circulation (ROSC) in OHCA patients using the data of the J-PULSE-Hypo Registry. This registry consisted of 14 institutes and retrospectively collected the patient after cardiac arrest to study the effect of TTM. These patients were divided into the PCI-first group and the TTM-first group to compare neurological outcomes. A favorable outcome was defined as a cerebral performance category (CPC) of 1–2. A total of 195 patients after cardiac arrest of cardiac etiology were enrolled in this present study. All patients underwent both PCI and TTM. There were no significant differences between the PCI-first group (n = 95) and the TTM-first group (n = 100) in the clinical characteristics. The PCI-first group had a longer median interval from collapse to achieve target core temperature (PCI-first, 330 [203–467] min vs. TTM-first, 179 [80–295] min; P < 0.01) than the TTM-first group. There were no significant differences in the rate of favorable outcome at 30 days (PCI-first, 54% vs. TTM-first, 50%; P = 0.67) between the two groups. The present multicenter registry study indicates that the timing of PCI did not significantly affect neurological outcome and survival in OHCA patients although PCI-first strategy delayed the induction of TTM.
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Abbreviations
- ACS:
-
Acute coronary syndrome
- CA:
-
Cardiac arrest
- CAG:
-
Coronary angiography
- CPC:
-
Cerebral performance category
- CPR:
-
Cardiopulmonary resuscitation
- IABP:
-
Intra-aortic balloon pumping
- LVEF:
-
Left ventricular ejection fraction
- OHCA:
-
Out-of-hospital cardiac arrest
- PCAS:
-
Post-cardiac arrest syndrome
- PCI:
-
Percutaneous coronary intervention
- PCPS:
-
Percutaneous cardiopulmonary support
- ROSC:
-
Return of spontaneous circulation
- TTM:
-
Target temperature management
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Acknowledgments
We thank all of the members of the J-PULSE-Hypo study group who participated in this multicenter observational study: Department of Cardiovascular Medicine, Division of Cardiovascular Care Unit, National Cerebral and Cardiovascular Center, Osaka; Department of Cardiology, Cardiopulmonary Resuscitation, and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, Tokyo; Emergency and Critical Care Center, Sapporo City University Hospital, Sapporo; Critical Care and Emergency Medical Center, Yokohama City University Medical Center, Yokohama; Emergency Medicine, Osaka Mishima Emergency Critical Care Center, Osaka; Emergency and Critical Care Medicine Center, Osaka City General Hospital, Osaka; Division of Cardiology, Osaka Police Hospital, Osaka; Senri Critical Care Medical Center, Saiseikai Senri Hospital, Osaka; Department of Cardiology, Sumitomo Hospital, Osaka; Emergency and Critical Care Center, Kagawa University Hospital, Kagawa; Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi; Division of Cardiology, Kokura Memorial Hospital, Kokura; and Department of Emergency Medicine, Saga University Hospital, Saga.
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Hosoda, H., Tahara, Y. (2018). Comparison of Neurological Outcome Between the Primary Percutaneous Coronary Intervention-First and Targeted Temperature Management-First Strategies in Out-of-Hospital Cardiac Arrest Patients: J-PULSE-Hypo Registry. In: Aibiki, M., Yamashita, S. (eds) A Perspective on Post-Cardiac Arrest Syndrome. Springer, Singapore. https://doi.org/10.1007/978-981-13-1099-7_2
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DOI: https://doi.org/10.1007/978-981-13-1099-7_2
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