Angiographic Characteristics of Coronary Disease and Postresuscitation Electrocardiograms in Patients With Aborted Cardiac Arrest Outside a Hospital

Post-Resuscitation ECG for Selection of Patients for Immediate Coronary Angiography in Out-of-Hospital Cardiac Arrest

“…11 Similarly, Radsel et al demonstrated acute culprit coronary lesions in 24% of patients without ST-segment-elevation. 21 This confirms the difficulty in selecting OHCA patients for ICA based on post-ROSC ECG with the risk of neglecting the existence of acute coronary lesions in patients without ST-segment-elevations. Interestingly, we found significant coronary disease and presumably acute coronary lesions in 32% of patients with initial nonshockable rhythms (pulseless electric activity, asystole) and in patients of all age groups, again demonstrating the difficulty to exclude selected patient groups from ICA.…”

“…19 A coronary occlusion was defined as TIMI grade 0 to 1 flow and considered acute or recent if there was angiographic evidence of thrombus at the site of occlusion or through the ability of opening the occluded artery by passing a guidewire easily through the lesion. 20,21 Reduced coronary flow was defined as TIMI grade 0 to 2 flow. Patients with chronic occlusions were categorized according to TIMI flow (0-3) in the remaining coronary arteries.…”

Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model

“…This preclinical, translational study shows such an approach is no better than when both cooling and reperfusion are delayed in a subject with an acute coronary occlusion. Cohort population studies of those without ST segment elevation post cardiac arrest have shown that at least one of every four such patients has an acutely occluded coronary (13)(14)(15)(16)(17). If immediate coronary angiography is not performed to find such occluded vessels, myocardium is lost and left ventricular function diminished.…”

“…Importantly, the 12-lead electrocardiogram post cardiac arrest has proven unreliable in identifying acutely occluded culprit coronary arteries (13,14). In these resuscitated patients the lack of ST segment elevation does not rule out an acute coronary occlusion.…”

How Much Is Enough

“…An aggressive approach to simultaneously cool and cath such patients on arrival at the hospital is favored by some interventional cardiologists. [1][2][3][4][5][6][7][8][9][10][11] Others remain unconvinced that such therapy is beneficial or needed.…”