Use of Continuous Positive Airway Pressure Ventilation as a Support During Coronary Angioplasty in Patients with Acute Myocardial Infarction: Safety and Feasibility.

Background/

Objectives

To evaluate the safety and feasibility of continuous positive airway pressure (CPAP) in patients with acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) during percutaneous coronary intervention (PCI). Non-invasive ventilation (NIV) is an established treatment for ADHF.

Methods

All consecutive patients admitted to Santa Croce Hospital of Cuneo, receiving CPAP for ADHF in the cath lab during PCI for AMI, were included in a case series.

Results

Between December 2018 and March 2021, 25 pts were included (median age 78 yrs, 48% female), with 64% of patients presenting with ST-elevation AMI and 17 (69%) in cardiogenic shock. At admission median left ventricular ejection fraction was 35 (20-60)% and eight (32%) patients had severe mitral regurgitation. Median PaO2/FiO2 was 183 (141-261) mmHg/%, lactate level 2.4 (1.3-3.8) mmol/L, and NTproBNP 7882 (3139-35,000) ng/L. CPAP was positioned and managed by nurses in all cases. Median FiO2 was 50 (35-100)% and median positive end-expiratory pressure was 7.5 (5-12) cmH2O. CPAP was generally well tolerated in 22 (88%) patients. One patient suffered cardiac arrest that led to CPAP interruption due to resuscitation maneuvers. No patient required orotracheal intubation in the cath lab. The post-procedural PaO2/FiO2 ratio substantially improved to 230 (175-356) mmHg/% (p = 0.007) and lactate decreased to 1.5 (1.0-1) mmol/L (p = 0.002). One patient died during hospital stay due to underlying disease, unrelated to the study procedure.

Conclusions

CPAP during PCI in patients with AMI and ADHF seems feasible, safe, and well tolerated. Larger studies are warranted to confirm these results.