title: Cardiac Arrest in Acute Myocardial Infarction: Concept of Circulatory Support With Mechanical Chest Compression and Impella to Facilitate Percutaneous Coronary Intervention.
abstract: Cardiogenic shock in the context of acute ST-elevation myocardial infarction (STEMI) remains a challenge to manage and results in significant mortality and morbidity, cardiac arrest in this setting even more so. The increase in myocardial oxygen demand and consumption with the use of inotropes is recognised as increasing mortality. Alternatives include the intra-aortic balloon pump (IABP), which has yet to be shown to improve outcomes, and extracorporeal membrane oxygenation (ECMO), which requires super-specialised techniques not widely available. We report a case of Anterior STEMI from a left main stem occlusion suffering with cardiac arrest on reaching the catheter laboratory table necessitating external mechanical compression with an Autopulse™. The patient remained in pulseless electrical activity (PEA) throughout, and was Autopulse dependent despite successful percutaneous coronary intervention (PCI). An Impella®was inserted for additional mechanical support and facilitated successful weaning from cardiopulmonary resuscitation (CPR). Despite 105minutes without a spontaneous output, we describe the first documented case of simultaneous use of Impella with mechanical CPR with a successful outcome; demonstrating a potential technique of good mechanical haemodynamic support to aide early revascularisation that may have potential utility in the treatment of cardiogenic shock and arrest.
authors.affiliation: King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, England; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The Kolling Institute, Northern Clinical School, University of Sydney, Australia. Electronic address: kaleab.asrress@sydney.edu.au.
authors.forename: Kaleab N
authors.initials: KN
authors.lastname: Asrress
authors.affiliation: King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, England.
authors.forename: Maciej
authors.initials: M
authors.lastname: Marciniak
authors.affiliation: King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, England.
authors.forename: Natalia
authors.initials: N
authors.lastname: Briceno
authors.affiliation: King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, England.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
mesh_terms: D035641:Chest Wall Oscillation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006323:Heart Arrest / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*
keywords: Automated CPR; Cardiac arrest; Circulatory support; Percutaneous coronary intervention