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Background. The LUCAS-2/-3 (Lund University Cardiopulmonary Assist System-2/-3) was developed for automatic chest compressions during cardiopulmonary resuscitation (mechanical CPR or MCPR) and often allows a patient suffering from cardiac arrest to be taken to the cardiac catheterisation room. We report the clinical outcomes of percutaneous coronary interventions (PCI) performed in cardiac arrest patients under automatic MCPR devices.
Methods. We retrieved all patients with cardiac arrest who were referred to PCI under MCPR devices from the Cardio-FR database (003-REP-CER-FR) from January 2016 to December 2021. Patients who were hemodynamically stable at the time of the coronary examination/intervention (even those who had been resuscitated immediately before) were excluded from the analysis. Baseline patient and procedure characteristics were collected. The primary outcome was the return of spontaneous circulation (ROSC).
Results. Of all patients who were on MCPR at the cardiac catheterisation room, 11 still required active CPR during coronary examination/intervention and were included in the analysis. Mean age was 67.9±10 years, 9 were male. The MCPR device was initiated on average after 8.5±8.1 minutes. All patients had ventricular defibrillation and received an average of 3.4±3.6 shocks and 82% adrenaline boluses. The MCPR was used for an average of 51.1±34.4 minutes. Total resuscitation time was on average 59.6±38.3 minutes. Of the 11 patients, 9 underwent ad hoc PCI. ROSC was achieved in 4 patients after 36.5±49.8 min. The survival was 36% (4 patients) at 24 hours and 27% (3 patients) at 3 months. Only one of the patients resuscitated for >25 minutes survived. Patients with in-hospital cardiac arrest were associated with shorter ROSC (p0.01), shorter resuscitation time (p=0.009) and better survival (p=0.03) than patients with out-of-hospital cardiac arrest.
Conclusions. MCPR allows patients in cardiac arrest to reach the cardiac catheterisation room. However, the prognosis is grim with high mortality. One patient survived after >25 minutes of mechanical resuscitation.
Introduction : The diagnosis and characterization and intracardiac tumors is often challenging. Transesophageal echocardiographic guided biopsy is an established method to confirm the pathology. Intracardiac echography (ICE) may help to increase the diagnostic yield of biopsies, particularly in right-sided cardiac masses.
Case report: We report on a 62-year-old gentleman who presented with recurrent pericardial effusions of unknown origin. Pericardial puncture was performed and did not reveal any significant findings. Positron-emission tomography-computed tomography (PET CT) revealed a mass in the right atrium. Due to excellent nearfield imaging capacities for right-sided cardiac structures, intracardiac echography (ICE) was used to guide biopsy. Biopsy was performed safely and demonstrated primary cardiac angiosarcoma.
Conclusion: ICE-guided biopsy may be a reasonable approach, particularly for right-sided structures, thereby allowing a safe, minimally invasive way of diagnosing intracardiac tumors.
We present the case of a 34-year-old man who presented with paroxysmal narrow complex tachycardia. An electrophysiologic study revealed AVNRT with upper common pathway block. Our case shows a diagnostic approach and treatment for this rare situation.
The scimitar syndrome in adults can easily be overlooked due to mild or non-existing symptoms. It is essential to diagnose and treat it before right heart dysfunction develops. Progressive right heart failure increases the periprocedural risk or even represents a contraindication to surgery. Though, when detected early, surgical correction can be performed safely with good clinical outcome.