Coronary intervention on a moving target: a case report and procedural considerations

Area of Science:

• Cardiology
• Emergency Medicine
• Interventional Cardiology

Background:

• Cardiac arrest, often caused by coronary disease, has high mortality and neurological sequelae among survivors.
• Early and effective resuscitation is crucial for improving outcomes in cardiac arrest patients.
• ST-elevation myocardial infarction (STEMI) leading to ventricular fibrillation (VF) cardiac arrest presents a critical therapeutic challenge.

Observation:

• A case of out-of-hospital STEMI and VF cardiac arrest is presented.
• Mechanical chest compressions were employed to support the patient during resuscitation.
• Coronary angiography and primary percutaneous coronary intervention (PCI) were performed during ongoing VF.

Findings:

• Mechanical chest compressions provided sufficient perfusion pressure to allow coronary angiography during VF.
• This facilitated successful primary PCI, a novel achievement during active cardiac arrest.
• The patient maintained neurological function and survived despite a 79-minute delay between arrest and PCI.

Implications:

• Mechanical chest compressions can facilitate life-saving interventional procedures during cardiac arrest.
• This case demonstrates the feasibility of primary PCI in STEMI patients experiencing VF arrest.
• Further research into the practical considerations and broader application of mechanical CPR in interventional cardiology is warranted.