Revascularization During Cardiac Arrest While Receiving Extracorporeal Life Support in Patients With Acute Myocardial Infarction.

Extracorporeal cardiopulmonary resuscitation (ECPR) has allowed patients with refractory out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI) to receive primary percutaneous coronary intervention (PCI); they were previously ineligible. The purpose of this study was to clarify the characteristics and outcomes of patients with OHCA secondary to AMI who underwent primary PCI during refractory cardiac arrest despite ECPR. Patients with AMI and OHCA aged ≥18 years who underwent PCI with ECPR in 2013 to 2018 were identified from a multicenter ECPR registry in Japan. The primary outcome was in-hospital mortality. We also assessed possible predictors of survival to discharge using mixed effects logistic regression to account for group differences among facilities. Among 671 patients with AMI and OHCA who underwent PCI with ECPR from 30 institutions, 251 (37%) patients had refractory cardiac arrest despite ECPR initiation and subsequently underwent primary PCI. Following coronary reperfusion, 64.9% (163/251) of patients achieved the sustained return of spontaneous circulation (ROSC), 21.1% (53/251) survived, and 10.4% (26/251) had favorable neurological status at hospital discharge. Multivariable analysis revealed that intermittent prehospital ROSC (OR: 5.22; 95% CI: 1.54-17.79), shorter time to ECPR initiation (OR: 0.89; 95% CI: 0.82-0.98), and postprocedural TIMI flow grade 3 (OR: 5.08; 95% CI: 1.50-17.22) are significantly associated with survival to hospital discharge. Among patients with AMI and refractory OHCA treated with ECPR, one-third did not have sustained ROSC prior to PCI. Of those, two-thirds achieved sustained ROSC following reperfusion and one-fifth survived to discharge.