Cardiac Arrest During Percutaneous Coronary Intervention

Introduction

Percutaneous coronary intervention, or PCI, is a procedure in which the blockages present in the coronary arteries (blood vessels supplying the heart) are treated. Sometimes during the PCI procedure, there can be a chance of cardiac arrest, which is considered to be a life-threatening emergency. In cardiac arrest, the heart will suddenly stop beating, resulting in cessation of breathing, lack of pulse, and unconsciousness. It is an emergency condition requiring immediate treatment to restore the heart's function and avoid damage or brain death.

In people who have cardiac arrest during the introduction of a PCI catheter, immediate cardiopulmonary resuscitation (CPR) will be given by the medical team to restore the function of the heart. Defibrillation is also used by delivering an electric shock to the heart, which helps regain the normal rhythm. The medical professional will also identify the underlying cause of the cardiac arrest.

What Is Percutaneous Coronary Intervention (PCI)?

Percutaneous coronary intervention or PCI is a minimally invasive medical procedure used in treating the blockages in the coronary artery that supply blood to the muscles in the heart. A thin, flexible catheter tube is inserted into the blocked blood vessels or arteries. After placing the catheter in position, the small balloon present at the tip is inflated, which helps compress the blockage or plaque and helps restore the flow of the blood. In many cases, a stent or a small mesh is placed to keep the artery in an open position. PCI is used as a common treatment in cases of heart and coronary artery disease and can help reduce symptoms like shortness of breath and chest pain. It can also help in decreasing the chance of heart attack and various other complications.

What Are the Incidence and Causes of Cardiac Arrest During PCI?

Cardiac arrest during PCI occurs in less than one percent of the cases, and it is very rare but can lead to serious complications. It can occur depending on the medical history and the complexity of the procedure. Some of the causes of cardiac arrest during PCI can be due to the patient's underlying medical condition. The common causes of cardiac arrest during PCI include the following:

• Ventricular Arrhythmias - Ventricular fibrillation, a type of ventricular arrhythmias, can be seen during the PCI because of the change in the heart's electrical activity or due to the introduction of catheters in the chambers of the heart.

• Coronary Artery Spasm - Sudden narrowing of the coronary artery is called coronary artery spasm, which can occur during the PCI technique and will reduce blood flow to the heart muscle and can result in cardiac arrest.

• Myocardial Infarction - During the PCI technique, while introducing catheters, blood clots will form, which can result in heart attack and cardiac arrest.

• Allergic Reaction - In rare cases, people can have allergic reactions to some medications used during the medical procedure that will trigger anaphylaxis (a potentially life-threatening reaction due to allergy which happens immediately after the exposure to the allergic agent) and result in cardiac arrest.

What Are the Signs and Symptoms of Cardiac Arrest During PCI?

The common signs and symptoms of cardiac arrest during PCI include the following:

• There will be a sudden loss of consciousness, and the patient will become unresponsive during the technique.

• There will be an absence of pulse, especially in the body's major arteries like femoral or carotid arteries, and it is a common sign of cardiac arrest.

• Reduced breathing or absence of breathing is another common sign of cardiac arrest.

• Discomfort or chest pain can be seen in some patients before the onset of cardiac arrest. It is a sign of an underlying coronary disease.

• Nausea, vomiting, or sweating can be seen before or during cardiac arrest.

How Is Cardiac Arrest During PCI Diagnosed and Evaluated?

Cardiac arrest during PCI is diagnosed and evaluated using the following methods:

• Continuous Monitoring - The patients' vital signs, like blood pressure, oxygen saturation, and heart rate, will be monitored continuously to assess the coronary status and determine the treatment response.

• Electrocardiography (ECG) - Electrocardiography helps identify any abnormal rhythms of the heart or changes in electrical activity that can result in cardiac arrest.

• Blood Tests - Some blood tests, like troponin levels, can help identify damage to the heart's muscles that occurred during cardiac arrest.

• Imaging Studies - Some imaging studies like angiography or echocardiography help identify underlying functional or structural abnormalities present in the blood vessels or heart that can result in cardiac arrest.

• Assessment of Risk Factors - The risk factors of the patient will be assessed, and the underlying medical conditions will be evaluated.

What Is the Management and Treatment of Cardiac Arrest During PCI?

Cardiac arrest during PCI is treated using the following methods:

• Immediate Resuscitation - The medical team will immediately initiate CPR when cardiac arrest occurs. They will also use a defibrillator to restore the heart's normal rhythm. These methods restore oxygenated blood circulation throughout the body and avoid damage to the brain and other complications.

• Identifying and Treating Underlying Cause - The underlying cause will be identified and treated immediately to prevent complications. Cardiac arrest can occur due to ventricular arrhythmias, myocardial infarction, or coronary artery spasm. Medications are used to reduce arrhythmias and coronary artery spasms. Surgical procedures like stent placement or balloon angioplasty are done to restore blood flow to the heart.

• Post-Cardiac Arrest Care - After restoring the normal heart rhythm, the patient is transferred to the intensive care unit and closely monitored. Oxygen therapy, mechanical ventilation, and medications are also used. The vital signs are monitored carefully.

• Preventing Future Cardiac Events - After stabilizing the patient to prevent future cardiac events, underlying causes will be addressed, and a treatment plan will be developed based on the patient's needs. Lifestyle modification, surgical procedures, or medications can be included during this phase.

Conclusion

In conclusion, cardiac arrest during PCI is a rare complication but has serious risks during the procedure. Many factors, including patient, procedure, and equipment-related factors, can cause it. Immediate recognition of cardiac arrest and effective management is needed to improve the patient's outcome and decrease the risk and complications. Defibrillation and advanced life support measures are used to treat cardiac arrest during PCI.