Feasibility and Safety of Distal Transradial Access in Patients With Out‐of‐Hospital Cardiac Arrest Undergoing Emergency PCI: A Single‐Center Retrospective Study

BACKGROUND: Distal transradial access (dTRA) has gained attention for its lower risk of vascular complications compared to conventional transradial access (TRA). However, its feasibility and safety in patients with out-of-hospital cardiac arrest (OHCA) undergoing emergency percutaneous coronary intervention (PCI) remain uncertain. AIM: To evaluate the procedural success, safety, and clinical outcomes of dTRA in OHCA patients undergoing emergency PCI. METHODS: This retrospective single-center study included 48 OHCA patients who underwent emergency PCI for presumed coronary etiology between January 2022 and December 2025. dTRA was the default access strategy unless contraindicated. Among them, dTRA was attempted in 44 patients. Patients in whom dTRA was successfully achieved were included in the main analysis. Clinical, procedural, and outcome data were comprehensively reviewed, including access-site complications and neurological status. RESULTS: dTRA was successfully achieved in 43 of 44 attempted cases (97.7%). The median door-to-balloon time was 67 min. Mechanical circulatory support was used in 38 patients (extracorporeal membrane oxygenation: 17; intra-aortic balloon pumping: 29). Access-site complications included one case of limb ischemia requiring amputation and three minor hematomas (EASY classification grade 3-5) with no major bleeding (BARC 3-5). The 30-day mortality was 51.2% (22/43), and among the 21 survivors, 14 (66.7%) achieved a favorable neurological outcome (CPC 1-2). CONCLUSIONS: In this OHCA cohort requiring emergency PCI, dTRA was feasible and safe in the majority of patients, including those receiving mechanical support. However, critical ischemic complications may still occur under unstable systemic conditions, warranting careful patient selection and vigilant post-procedural monitoring.