Coronary angiography in cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation

BACKGROUND: The use of extracorporeal cardiopulmonary resuscitation (ECPR) is emerging. In cardiac arrest patients with return of spontaneous circulation (ROSC), the electrocardiogram (ECG) guides the need for immediate coronary angiography (CAG). In ECPR patients, the diagnostic value of the ECG and the role of CAG remain unclear. METHODS: This single-centre, retrospective study included all adult ECPR patients admitted to Amsterdam UMC (2018-2024). ECPR was defined as cannulation on venoarterial extracorporeal membrane oxygenation during ongoing continuous or intermittent resuscitation, before sustained ROSC (≥ 20 min). The primary outcome included the presence and extent of coronary artery disease (CAD). Logistic regression was used to identify predictors of undergoing CAG and having a culprit. The impact of CAG on survival was assessed using Cox proportional hazard models and Kaplan-Meier curves. RESULTS: Ninety-two patients (mean age of 53 years, 65% male) were included, with 70% presenting after out-of-hospital cardiac arrest and 52% with an initial shockable rhythm. Survival to discharge was 18%. Survivors more often had intermittent ROSC and were less often obese. CAG was performed in 59%, revealing significant CAD in 94%, multivessel disease in 60%, and a culprit lesion in 78%. Revascularisation occurred in 74%. Among patients with ST-segment elevations, those without CAG had higher in-hospital mortality (HR 4.06, 95%CI 1.72-9.61). CONCLUSION: The presence of CAD and culprit lesions was high among ECPR patients undergoing CAG. Early CAG was associated with a benefit in patients with ST-segment elevations. Further research is necessary to evaluate the benefit of early CAG in patients without ST-segment elevation.