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. 2022 Apr 1;12(2):e12066.
doi: 10.1002/pul2.12066. eCollection 2022 Apr.

Outcomes of cardiopulmonary resuscitation in patients with pulmonary arterial hypertension

Jenny Z Yang  1 , Mazen F Odish  1 , Hannah Mathers  2 , Nicole Pebley  2 , Gabriel Wardi  1 , Demosthenes G Papamatheakis  1 , David S Poch  1 , Nick H Kim  1 , Timothy M Fernandes  1 , Rebecca E Sell  1
Affiliations

Outcomes of cardiopulmonary resuscitation in patients with pulmonary arterial hypertension

Jenny Z Yang et al. Pulm Circ. .

Abstract

Over the past 20 years, despite significant advancements in pulmonary arterial hypertension (PAH) medical therapy, many patients require admission to the hospital and are at risk for in-hospital cardiac arrest (IHCA). Prior data found poor survival in PAH patients after cardiac arrest. The purpose of this study was to explore post-IHCA outcomes in PAH patients receiving advanced medical therapies. This is a single-center retrospective study of PAH patients who underwent cardiopulmonary resuscitation for IHCA between July 2005 and May 2021. Patients were identified through an internal cardiac arrest database. Twenty six patients were included. Half of the cohort had idiopathic PAH, with 54% of patients on combination therapy, 27% on monotherapy, and 19% of patients on no therapy. Mean right atrial pressure, mean pulmonary artery pressure, cardiac index, and pulmonary vascular resistance were 13 ± 6 mmHg, 57 ± 13 mmHg, 2.0 ± 0.7 L/min/m2, and 14.5 ± 7.6 Wood units, respectively. Most common etiology of cardiac arrest was circulatory collapse. Initial arrest rhythm in all but one patient was pulseless electrical activity. Six patients (23%) achieved return of spontaneous circulation (ROSC) and one patient (4%) survived to hospital discharge. Rates of ROSC and survival to discharge after IHCA are poor in patients with PAH. Even patients with mild hemodynamics had low likelihood of survival. In patients who are lung transplant candidates, there should be early consideration of extracorporeal support before cardiac arrest.

Keywords: CPR; in‐hospital cardiac arrest; pulmonary hypertension; pulseless electrical activity.

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Conflict of interest statement

Gabriel Wardi is supported by the National Foundation of Emergency Medicine and receives funding from the Gordon and Betty Moore Foundation (#GBMF9052) and the National Institutes of Health, although not related to this study. Demosthenes G. Papamatheakis has received honoraria from Janssen PH. Timothy M. Fernandes has served as consultant for Bayer and Janssen PH. Nick H. Kim has served as consultant/steering committee for Bayer, Gossamer Bio, Janssen, Merck, United Therapeutics; Speakers Bureau for Bayer, Janssen; and has received research support from Acceleron, Bellerophon, Eiger, Lung Biotechnology, and SoniVie. The remaining authors report no relevant disclosures or conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of patients who were screened, excluded, and included in the final analysis. CTEPH, chronic thromboembolic pulmonary hypertension; DNR/DNI, do not resuscitate/do not intubate; IHCA, in‐hospital cardiac arrest; PAH, pulmonary arterial hypertension; PH, pulmonary hypertension; TTE, transthoracic echocardiography.
Figure 2
Figure 2
Cycle of the right ventricular failure leading to cardiovascular collapse. BP, blood pressure; LV, left ventricle; PAH, pulmonary arterial hypertension; RV, right ventricle.
See this image and copyright information in PMC

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