A systematic review and meta-analysis of the effect of routine early angiography in patients with return of spontaneous circulation after Out-of-Hospital Cardiac Arrest

Abstract

Background: Early coronary angiography (CAG) has been reported in individual studies and systematic reviews to significantly improve outcomes of patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA).Methods: We undertook a systematic review and meta-analysis to evaluate the impact of early CAG on key clinical outcomes in comatose patients after ROSC following out-of-hospital CA of presumed cardiac origin. We searched the PubMED, EMBASE, CINAHL, ERIC and Cochrane Central Register of Controlled Trials databases from 1990 until April 2020. Eligible studies compared patients undergoing early CAG to patients with late or no CAG. When randomized controlled trials (RCTs) existed for a specific outcome, we used their results to estimate the effect of the intervention. In the absence of randomized data, we used observational data. We excluded studies at high risk of bias according to the Robins-I tool from the meta-analysis. The GRADE system was used to assess certainty of evidence at an outcome level.Results: Of 3738 citations screened, 3 randomized trials and 41 observational studies were eligible for inclusion. Evidence certainty across all outcomes for the RCTs was assessed as low. Randomized data showed no benefit from early as opposed to late CAG across all critical outcomes of survival and survival with favourable neurologic outcome for undifferentiated patients and for patient subgroups without ST-segment-elevation on post ROSC ECG and shockable initial rhythm. Conclusion:These results do not support routine early CAG in undifferentiated comatose patients and patients without STE on post ROSC ECG after OHCA.

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

“…CACs are specialized tertiary institutions, conceptually similar to level 1 trauma centers, and are often high‐volume or regionalized centers treating patients with OHCA with the capability to organize postresuscitation care, including 24/7 access to a cardiac catheterization laboratory for coronary angiography and percutaneous coronary intervention (PCI), TTM, extracorporeal membrane oxygenation, and neuroprognostication among other interventions. 12 , 13 , 14 However, although there has been evidence for the effectiveness of each individual intervention in variable settings, 15 , 16 , 17 , 18 , 19 evidence for the benefit of CACs in treating patients with OHCA remain inconclusive. This is in part because CACs, which provide a complex bundle of interventions, have been poorly defined, 10 , 20 and similar institutions described in published literature may range from exhibiting only a few to many of the defining traits of a CAC.…”

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

“…The search was updated this year to incorporate a new RCT on this topic and to identify any other relevant studies since publication of the previous SysRev. The original review was registered on PROSPERO (CRD42020160152) 114.…”

Post-Cardiac Arrest Syndrome

“…For contact-to-balloon times ranging from 60 to 180 minutes, every 10-minute treatment delay resulted in 2.09 additional deaths in 100 percutaneous coronary intervention-treated OHCA patients with cardiogenic shock. The optimal timing of coronary angiography in patients without signs of ongoing myocardial ischemia or ST-segment elevation on their ECG has been debated 12. The outcome of recent randomized controlled trials comparing early with delayed coronary angiography13–15 has been evaluated by meta-analysis 16.…”