title: Early coronary revascularization improves 24h survival and neurological function after ischemic cardiac arrest. A randomized animal study.
abstract: BACKGROUND
  Survival after out-of-hospital cardiac arrest (OHCA) remains poor. Acute coronary obstruction is a major cause of OHCA. We hypothesize that early coronary reperfusion will improve 24h-survival and neurological outcomes.
  
  
  METHODS
  Total occlusion of the mid LAD was induced by balloon inflation in 27 pigs. After 5min, VF was induced and left untreated for 8min. If return of spontaneous circulation (ROSC) was achieved within 15min (21/27 animals) of cardiopulmonary resuscitation (CPR), animals were randomized to a total of either 45min (group A) or 4h (group B) of LAD occlusion. Animals without ROSC after 15min of CPR were classified as refractory VF (group C). In those pigs, CPR was continued up to 45min of total LAD occlusion at which point reperfusion was achieved. CPR was continued until ROSC or another 10min of CPR had been performed. Primary endpoints for groups A and B were 24-h survival and cerebral performance category (CPC). Primary endpoint for group C was ROSC before or after reperfusion.
  
  
  RESULTS
  Early compared to late reperfusion improved survival (10/11 versus 4/10, p=0.02), mean CPC (1.4±0.7 versus 2.5±0.6, p=0.017), LVEF (43±13 versus 32±9%, p=0.01), troponin I (37±28 versus 99±12, p=0.005) and CK-MB (11±4 versus 20.1±5, p=0.031) at 24-h after ROSC. ROSC was achieved in 4/6 animals only after reperfusion in group C.
  
  
  CONCLUSIONS
  Early reperfusion after ischemic cardiac arrest improved 24h survival rate and neurological function. In animals with refractory VF, reperfusion was necessary to achieve ROSC.
authors.affiliation: Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France. Electronic address: georgios.sideris@lrb.aphp.fr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sideris
authors.affiliation: Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Magkoutis
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
authors.forename: Alok
authors.initials: A
authors.lastname: Sharma
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rees
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: McKnite
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Caldwell
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Sarraf
authors.affiliation: Lariboisiere Hospital, AP-HP-Paris Diderot University, INSERM U942, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
authors.forename: Keith
authors.initials: K
authors.lastname: Lurie
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: University of Minnesota, Cardiovascular division, Interventional Cardiology Section, Cardiology department, Minneapolis, MN, United States. Electronic address: yanno001@umn.edu.
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
mesh_terms: D000638:Amiodarone / Q000494:pharmacology; D000818:Animals; D006328:Cardiac Catheterization; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D004452:Echocardiography; D004554:Electric Countershock; D004562:Electrocardiography; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D006323:Heart Arrest / Q000601:surgery* / Q000628:therapy; D008991:Monitoring, Physiologic; D011897:Random Allocation; D012121:Respiration, Artificial; D015996:Survival Rate; D013552:Swine
chemical_list: D000638:Amiodarone; D004837:Epinephrine
keywords: 24h Survival rate; ACD; ACLS; CK-MB; CPC; CPR; Cerebral performance category (CPC) score; Early coronary revascularization; ITD; OHCA; ROSC; Return of spontaneous circulation (ROSC).; VF; VT; active compression decompression; advanced cardiac life support; cardiopulmonary resuscitation; cerebral performance category; creatine kinase-MB; impendence threshold device; out of hospital cardiac arrest; return of spontaneous circulation; ventricular fibrillation; ventricular tachycardia