Distal radial access for emergency PCI in out-of-hospital cardiac arrest: a single-centre experience

Background Distal radial access has gained popularity in percutaneous coronary intervention (PCI) for its potential to reduce vascular complications and enhance patient comfort. However, data remain limited in patients with out-of-hospital cardiac arrest (OHCA), who undergo emergency PCI under unstable hemodynamic conditions. Purpose To evaluate the feasibility and safety of distal radial access in Utstein-defined OHCA patients undergoing emergency PCI. Methods This retrospective, single-centre study included consecutive patients with out-of-hospital cardiacarrest (OHCA) admitted between January 2022 and May 2025. Among 748 patients who experienced OHCA and met the Utstein-defined criteria, 47 underwent emergency percutaneous coronary intervention (PCI) for a presumed coronary cause. Vascular access routes were selected based on clinical judgement. Distal radial access was attempted in all eligible cases, unless contraindicated (e.g., in patients receiving haemodialysis or when puncture attempts failed). We analysed procedural characteristics, access-site complications, use of mechanical circulatory support, 30-day survival, and neurological outcomes. Results The mean patient age was 69.2 ± 10.8 years; 14 (29.8%) were female. Distal radial access was used in 42 (89.4%) cases. Other routes included femoral (n=3), conventional radial (n=1), and brachial (n=1). One patient required crossover from distal radial to brachial due to puncture failure. Among the 42 distal radial cases, culprit lesions were identified in the LAD (n=18), RCA (n=17), LCX (n=5), and left main trunk (n=2). The mean door-to-balloon time was 66.7 ± 27.1 minutes. Mechanical circulatory support was utilised in 36 patients: extracorporeal membrane oxygenation (ECMO) in 17 (36.2%) and intra-aortic balloon pump (IABP) in 28 (59.6%). Access-site complications included three cases of bleeding and one radial artery occlusion. The 30-day survival rate was 44.7%, and neurologically favourable outcome (Cerebral Performance Category 1 or 2) was observed in 36.2% of patients. Conclusion Distal radial access was technically feasible and safe in OHCA patients undergoing emergency PCI, with low crossover and complication rates. However, haemodynamic deterioration and systemic inflammatory response may contribute to vascular complications. Careful access selection and vigilant neurological and vascular monitoring are warranted in this high-risk population.