Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)—An initial pilot-study of a randomized clinical trial

Elfwén, Ludvig; Lagedal, Rickard; Nordberg, Per; James, Stefan; Oldgren, Jonas; Böhm, Felix; Lundgren, Peter; Rylander, Christian; Linden, Jan van der; Hollenberg, Jacob; Erlinge, David; Cronberg, Tobias; Jensen, Ulf; Friberg, Hans; Lilja, Gisela; Larsson, Ing Marie; Wallin, Ewa; Rubertsson, Sten; Svensson, Leif

doi:10.1016/j.resuscitation.2019.04.027

Cited by 62 publications

(50 citation statements)

References 17 publications

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“…57 The RCTs were conducted in the Netherlands, 10 US 16 and Sweden. 17 The observational studies were conducted in Europe (n = 18: France n = 7; Czech Republic n = 3; Denmark and Italy n = 2; Austria, Netherlands, Norway, Sweden n = 1), Northern America (n = 14: USA n = 12, Canada n = 2), Australia (n = 3), Asia (n = 3; Korea n = 2; Oman n = 1), and multiple countries (n = 3).…”

Section: Resultsmentioning

confidence: 99%

“…One RCT included 552 patients, 10 another RCT (n = 99) was prematurely terminated before enrolling the target number of patients 16 while the third was a pilot study (n = 79) to investigate feasibility and safety aspects of randomization. 17 The observational studies included a total of 34,472 patients (Table 1). As some databases generated multiple publications, the total number of patients may not represent the total number of individual cases of cardiac arrest.…”

Section: Resultsmentioning

confidence: 99%

“…The pilot RCT by Elfwen et al, 17 was assessed at high risk of bias for the efficacy outcomes because of its open label design and important deviations from the intended protocol.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

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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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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

et al. 2021

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“…On the other hand, in subgroup analysis of a RCT, treatment that avoided hyperoxia had benefit for 90-day survival with good neurological outcome. [9][10][11] Although four observational studies showed that targeted treat- (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). As a result, treatment targeting high hypercapnia did not have benefits compared to treatment targeting normal or low-normal hypocarbia.…”

Section: Airway and Breathingmentioning

confidence: 99%

“…Results revealed no difference in 30-day mortality between the two groups. 36,[41][42][43] In four observational studies comparing short-term mortality of patients who underwent coronary angiography immediately after hospital visit and those who did not undergo coronary angiography, patients who underwent coronary angiography immediately after the hospital visit showed lower mortality than those who did not undergo coronary angiography. 36,[43][44][45] In three observational studies comparing shortterm neurological outcome of patients who underwent coronary angiography immediately after admission to the hospital and those who underwent coronary angiography after neurological stabilization, there was no difference in short-term neurological outcome between the two groups.…”

Section: Investigation For the Causes Of Cardiac Arrest And Treatment Of Reversible Causes Intervention For Acute Coronary Syndromesmentioning

confidence: 99%

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

et al. 2021

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The 2020 Korean Post-cardiac Arrest Care Guidelines are medical recommendations derived based on scientific evidence for post-cardiac arrest care. These guidelines are based on the 2020 scientific consensus and treatment recommendations of the International Liaison Committee on Resuscitation and we additionally considered the research papers in the post-cardiac arrest care field which were published after the International Liaison Committee on Resuscitation review. 1,2 In these guidelines, topics which are clinically important and needed further consideration were reviewed in the form of adaptation or hybridization. Meta-analyses or scoping reviews for addi-S42 www.ceemjournal.org 2020 CPR guidelines: post-cardiac arrest care Use of prophylactic antibioticsThe benefit of the routine use of prophylactic antibiotics in pa-S43

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Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation

et al. 2023

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ImportanceMyocardial infarction is a frequent cause of out-of-hospital cardiac arrest (OHCA). The long-term effect of early coronary angiography on patients with OHCA with possible coronary trigger but no ST-segment elevation remains unclear.ObjectiveTo compare the clinical outcomes of early unselective angiography with the clinical outcomes of a delayed or selective approach for successfully resuscitated patients with OHCA of presumed cardiac origin without ST-segment elevation at 1-year follow-up.Design, Setting, and ParticipantsThe TOMAHAWK trial was a multicenter, international (Germany and Denmark), investigator-initiated, open-label, randomized clinical trial enrolling 554 patients between November 23, 2016, to September 20, 2019. Patients with stable return of spontaneous circulation after OHCA of presumed cardiac origin but without ST-segment elevation on the postresuscitation electrocardiogram were eligible for inclusion. A total of 554 patients were randomized to either immediate coronary angiography after hospital admission or an initial intensive care assessment with delayed or selective angiography after a minimum of 24 hours. All 554 patients were included in survival analyses during the follow-up period of 1 year. Secondary clinical outcomes were assessed only for participants alive at 1 year to account for the competing risk of death.InterventionsEarly vs delayed or selective coronary angiography and revascularization if indicated.Main Outcomes and MeasuresEvaluations in this secondary analysis included all-cause mortality after 1 year, as well as severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure in survivors at 1 year.ResultsA total of 281 patients were randomized to the immediate angiography group and 273 to the delayed or selective group, with a median age of 70 years (IQR, 60-78 years). A total of 369 of 530 patients (69.6%) were male, and 268 of 483 patients (55.5%) had a shockable arrest rhythm. At 1 year, all-cause mortality was 60.8% (161 of 265) in the immediate angiography group and 54.3% (144 of 265) in the delayed or selective angiography group without significant difference between the treatment strategies, trending toward an increase in mortality with immediate angiography (hazard ratio, 1.25; 95% CI, 0.99-1.57; P = .05). For patients surviving until 1 year, the rates of severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure were similar between the groups.Conclusions and RelevanceThis study found that a strategy of immediate coronary angiography does not provide clinical benefit compared with a delayed or selective invasive approach for patients 1 year after resuscitated OHCA of presumed coronary cause and without ST-segment elevation.Trial RegistrationClinicalTrials.gov Identifier: NCT02750462

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Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)—An initial pilot-study of a randomized clinical trial

Cited by 62 publications

References 17 publications

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

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

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation

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