Related Experiment Videos
Role of coronary artery surgery in patients surviving unexpected cardiac arrest
Insights
Survivors of cardiac arrest with ventricular fibrillation (VF) have poor long-term outcomes. Myocardial revascularization surgery in selected patients safely improved survival and reduced recurrent events.
Area of Science:
- Cardiology
- Cardiac Surgery
- Emergency Medicine
Background:
- Unexpected cardiac arrest (CA) with ventricular fibrillation (VF) has a high mortality rate.
- Survivors of initial CA resuscitation face poor intermediate and long-term prognoses, with high rates of sudden death due to recurrent VF.
Purpose of the Study:
- To evaluate the safety and efficacy of myocardial revascularization in survivors of unexpected CA.
- To assess the impact of surgical intervention on post-hospitalization survival and recurrent cardiac events.
Main Methods:
- Retrospective analysis of 101 patients resuscitated from CA (VF).
- Hemodynamic and coronary angiographic studies in 16 patients with pre-existing coronary heart disease symptoms.
- Follow-up of 8 patients who underwent myocardial revascularization surgery.
Main Results:
- All 8 patients undergoing myocardial revascularization survived the surgery.
- One late death occurred at 10 months; remaining patients survived 14-34 months, with 6 symptom-free.
- Despite patent grafts, one patient experienced a second serious arrhythmia.
Conclusions:
- Surgical intervention (myocardial revascularization) appears safe and may reduce mortality and recurrent arrest rates in selected CA survivors.
- All patients with unexpected CA should undergo post-arrest coronary catheterization and angiography.
- Antiarrhythmic agents are recommended for all CA survivors, irrespective of surgical intervention.
Abstract:
During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.