In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Introduction: The utility of extracorporeal cardiopulmonary resuscitation (ECPR) for patients with pulseless electrical activity (PEA) is still unclear and the appropriate patient selection is necessary. We evaluated the characteristics of patients with aortic dissection (AD), which is a major contraindication for ECPR, among patients with PEA using a city-wide (population=120.000) prospective registry of patients who experience out-of-hospital cardiac arrest (OHCA) whom cause of death are assessed by post-mortem computed tomography (PMCT). Methods and Results: 1373 patients who experienced OHCA between 2008 and 2020, and 1,235 (90%) were assessed their cause of death by CT in the city. 359 patients with PEA as an initial rhythm were finally included to this study and 44 had AD (12%). Female (OR, 2.37; 95% confidence interval [CI], 1.25-4.52; P=0.008), sudden onset (OHCA within 60 min from the onset of new symptoms) (OR, 2.61; 95% CI, 1.20-5.70; P=0.015), and the prevalence of hypertension (OR, 3.16; 95% CI, 1.45-6.88; P=0.004) were independently associated with the presence of AD. Based on the number of these 3 factors, the risk of AD was stratified into 0% (score 0), 12% (score 1 or 2) and 34% (score 3). Furthermore, among patients underwent post-resuscitation electrocardiogram (n=166), inferior segment ST depression was significantly associated with AD (OR, 3.89; 95% CI , 1.17-12.9; P=0.027) and its absence allowed us to identify low risk (4%) group in patients with score 1 or 2 (Figure). Conclusions: The risk of AD for OHCAs with PEA was 12%, but stratification based on interview and electrocardiography allowed us to identify lower risk groups (0% or 4%).
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.10523
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
