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Using vascular closure devices following out-of-hospital cardiac arrest?
Martin Christ1, Katharina Isabel von Auenmueller1, Jeanette Liebeton1
1Department of Cardiology and Angiology, Marienhospital Herne, Ruhr - University Bochum, Germany.
Insights
Vascular closure devices (VCDs) appear safe for out-of-hospital cardiac arrest (OHCA) patients undergoing mild therapeutic hypothermia (MTH). Complication rates were similar with VCDs versus manual compression, regardless of MTH treatment.
Area of Science:
- Cardiology
- Emergency Medicine
- Vascular Surgery
Background:
- Vascular closure devices (VCDs) are widely used after femoral artery access.
- The safety of VCDs in out-of-hospital cardiac arrest (OHCA) patients receiving mild therapeutic hypothermia (MTH) is not well-established.
Purpose of the Study:
- To evaluate the safety and feasibility of using VCDs in OHCA patients treated with MTH.
Main Methods:
- Retrospective study of OHCA patients undergoing coronary angiography.
- Comparison of vascular complication rates between VCDs and manual compression.
- Analysis of outcomes based on MTH treatment status.
Main Results:
- 76 patients were included; 34.2% received VCDs and 63.2% underwent MTH.
- Overall vascular complications were higher in the MTH group (12.5% vs 0.0%).
- Vascular complication rates were similar between VCDs and manual compression, irrespective of MTH.
Conclusions:
- Mild therapeutic hypothermia is associated with increased vascular complications after coronary angiography.
- Vascular closure devices are a feasible and safe option for OHCA patients treated with MTH.
- Careful patient selection is recommended when using VCDs in this population.
Objectives And Background:
Despite a generally broad use of vascular closure devices (VCDs), it remains unclear whether they can also be used in victims from out-of-hospital cardiac arrest (OHCA) treated with mild therapeutic hypothermia (MTH).
Methods:
All victims from OHCA who received immediate coronary angiography after OHCA between January 1(st) 2008 and December 31(st) 2013 were included in this study. The operator decided to either use a VCD (Angio-Seal™) or manual compression for femoral artery puncture. The decision to induce MTH was based on the clinical circumstances.
Results:
76 patients were included in this study, 46 (60.5%) men and 30 (39.5%) women with a mean age of 64.2 ± 12.8 years. VCDs were used in 26 patients (34.2%), and 48 patients (63.2%) were treated with MTH. While there were significantly more overall vascular complications in the group of patients treated with MTH (12.5% versus 0.0%; p=0.05), vascular complications were similar between patients with VCD or manual compression, regardless of whether or not they were treated with MTH.
Conclusion:
In our study, the overall rate of vascular complications related to coronary angiography was higher in patients treated with mild therapeutic hypothermia, but was not affected by the application of a vascular closure device. Therefore, our data suggest that the use of VCDs in victims from OHCA might be feasible and safe in patients treated with MTH as well, at least if the decision to use them is individually carefully determined.
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