Janet Friant

Mechanical chest compressions improve rate of return of spontaneous circulation and allow for initiation of percutaneous circulatory support during cardiac arrest in the cardiac catheterization laboratory

BACKGROUND Performing advanced cardiac life support (ACLS) in the cardiac catheterization laboratory (CCL) is challenging. Mechanical chest compression (MCC) devices deliver compressions in a small space, allowing for simultaneous percutaneous coronary intervention and reduced radiation exposure to rescuers. In refractory cases, MCC devices allow rescuers to initiate percutaneous mechanical circulatory support (MCS) and extracorporeal life support (ECLS) during resuscitation. This study sought to assess the efficacy and safety of MCC when compared to manual compressions in the CCL. METHODS We performed a retrospective analysis of patients who received ACLS in the CCL at our institution between May 2011 and February 2016. Baseline characteristics, resuscitation details, and outcomes were compared between patients who received manual and mechanical compressions. RESULTS Forty-three patients (67% male, mean age 58 years) required chest compressions for cardiac arrest while in the CCL (12 manual and 31 MCC). Patients receiving MCC were more likely to achieve return of spontaneous circulation (ROSC) (74% vs. 42%, p=0.05). Of those receiving MCC, twenty-two patients (71%) were treated with MCS. Patients receiving percutaneous ECLS were more likely to achieve ROSC (100% vs. 53%, p=0.003) and suffered no episodes of limb loss or TIMI major bleeding. There were no significant differences in 30-day survival or survival to hospital discharge between groups. CONCLUSIONS Use of MCC during resuscitation of cardiac arrest in the CCL increases the rate of ROSC. Simultaneous implantation of MCS, including percutaneous ECLS, is feasible and safe during MCC-assisted resuscitation in the CCL.

Predictors of survival following trans‐catheter aortic valve closure for left ventricular assist device associated aortic insufficiency

This study sought to assess the long‐term clinical benefits and predictors of survival of trans‐catheter aortic valve closure in left ventricular assist device (LVAD) patients.

Factors Associated with the Use of Drug-Eluting Stents in Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction.

Background. Drug-eluting stents (DES) have proven clinical superiority to bare-metal stents (BMS) for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Decision to implant BMS or DES is dependent on the patients ability to take dual antiplatelet therapy. This study investigated factors associated with DES placement in STEMI patients. Methods. Retrospective analysis was performed on 193 patients who presented with STEMI and were treated with percutaneous coronary intervention at an urban, tertiary care hospital. Independent factors associated with choice of stent type were determined using stepwise multivariate logistic regression. Odds ratio (OR) was used to evaluate factors significantly associated with DES and BMS. Results. 128 received at least one DES, while 65 received BMS. BMS use was more likely in the setting of illicit drug or alcohol abuse ([OR] 0.15, 95% CI 0.05–0.48, p ≤ 0.01), cardiogenic shock (OR 0.26, 95% CI 0.10–0.73, p = 0.01), and larger stent diameter (OR 0.28, 95% CI 0.11–0.68, p ≤ 0.01). Conclusions. In this analysis, BMS implantation was associated with illicit drug or alcohol abuse and presence of cardiogenic shock. This study did not confirm previous observations that non-White race, insurance, or income predicts BMS use.

Successful percutaneous trans‐catheter treatment of left ventricular assist device outflow graft stenosis with a covered stent

Left ventricular assist devices improve survival in patients with advanced heart failure but can be associated with significant complication including infection, pump thrombosis, and de novo severe aortic insufficiency. Outflow graft stenosis is a much more rare complication, but one with significant hemodynamic consequences. Surgical repair is often necessary, but many patients are too high risk for further surgical intervention. We describe the first case of left ventricular assist device outflow graft stenosis treated with percutaneous trans‐catheter placement of a covered stent.

Electronic cardiac arrest triage score best predicts mortality after intervention in patients with massive and submassive pulmonary embolism

To determine if the cardiac arrest triage (CART) Score would better predict poor outcomes after pharmacomechanical therapy (PMT) for massive and submassive pulmonary embolism (PE) than traditional risk scores

TCT-125 Use of a Mechanical Compression Device Increases Return of Spontaneous Circulation in Patients with Cardiac Arrest in the Cardiac Catheterization Laboratory .

Recent studies suggest that therapies offered in the cardiac catheterization laboratory (CCL) can increase survival in patients who have suffered a cardiac arrest. Performing advanced cardiac life support (ACLS) in the CCL is challenging due to the presence of imaging equipment and rescuer fatigue.

TCT-134 Mechanical Chest Compressions as a Bridge to Percutaneous Extracorporeal Life Support Increase Return of Spontaneous Circulation in Patients with Cardiac Arrest

Recent studies have reported that patients with cardiac arrest refractory to advanced cardiac life support (ACLS) may benefit from initiation of percutaneous extracorporeal life support (ECLS) during resuscitation. In order to preserve critical organ function, chest compressions must be performed

TCT-790 Cardiac Arrest Triage score best predicts mortality after intervention in patients with massive and submassive pulmonary embolism

Medical Centers, AMAGASAKI, Japan; Kansai Rosai Hospital, Cardiovascular Center, Amagasaki city, Japan; Kokura Memorial Hospital; Morinomiya Hospital, Osaka, Japan; Minneapolis Heart Institute Foundation; Saiseikai Central Hospital, Kyoto, Japan; Saiseikai Yokohama-city Eastern Hospital; AstraZeneca; Nagoya Kyoritsu Hospital, Nagoya, Japan; Kyoto university Hospital, Kyoto, Japan; University of North Carolina Hospital; Fukuoka, Japan; Sant’Eugenio Hospital, Rome, Italy; Juntendo University Nerima Hp., Tokyo, Japan; Hospital of León; Kanazawa Cardiovascular Hospital, Ishikawa, Japan; shinshu university hospital, Matsumoto, Japan; Tokai University, Isehara, Japan; Sant’Eugenio Hospital, Rome, Italy; Hofstra Northwell School of Medicine