Immediate coronary angiogram in out-of-hospital cardiac arrest patients with non-shockable initial rhythm and without ST-segment elevation — Is there a clinical benefit?

Voicu, Sébastian; Bajoras, Vilhelmas; Gall, Emmanuel; Deye, Nicolas; Malissin, Isabelle; Dillinger, Jean‐Guillaume; Benajiba, Chakib; Logeart, Damien; Henry, Patrick; Mégarbane, Bruno; Sidéris, Georgios

doi:10.1016/j.resuscitation.2020.06.022

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…Generally, the causes of OHCA with non-shockable rhythm are diverse such as cardiogenic, respiratory causes, sepsis, subarachnoid hemorrhage, electrolyte abnormality and etc. 17 , 18 , 19 , 20 , 21 Despite the application of ECPR and appropriate treatment for the underlying cause, some patients with non-shockable rhythm do not achieve good neurological function. This is because the primary cause of cardiac arrest itself can severely injure the brain, leading to poor neurological outcomes despite intervention.…”

Section: Discussionmentioning

confidence: 99%

“…This is because the primary cause of cardiac arrest itself can severely injure the brain, leading to poor neurological outcomes despite intervention. 17 , 18 , 19 , 20 , 21 For example, in patients with cardiac arrest because of hypoxia due to respiratory failure or a massive intracranial hemorrhage, the brain is likely to be severely injured when ECPR started. 8 , 22 Indeed, survival was better in patients with scores 3 or 4, but neurological outcomes were similar to the other groups.…”

Section: Discussionmentioning

confidence: 99%

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Application of the TiPS65 score for out-of-hospital cardiac arrest patients with initial non-shockable rhythm treated with ECPR

Okada,

Kandori

et al. 2023

Resuscitation Plus

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Application of the TiPS65 score for out-of-hospital cardiac arrest patients with initial non-shockable rhythm treated with ECPR

Okada,

Kandori

et al. 2023

Resuscitation Plus

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“…Moreover, in survivors of OHCA with non-shockable rhythm, CAG is not necessarily performed, which potentially leads to ascertainment bias regarding the prevalence of CAD. However, a low prevalence of culprit lesions (1%) in consecutive patients with OHCA and non-shockable initial rhythm compared with shockable rhythm (22%) (p < 0.001) was reported [15].…”

Section: Epidemiology Of Cad In Ohcamentioning

confidence: 94%

“…Indeed, futile procedures in patients with the most severe brain damage who would die from neurological failure regardless of coronary status may be avoided using prognostic scores [29][30][31]. Moreover, unwitnessed cardiac arrest, the presence of an initial non-shockable rhythm, and prolonged duration of no/low flow should strongly argue against futile early CAG [15].…”

Section: Current Evidencementioning

confidence: 99%

Percutaneous Coronary Intervention in Out-of-Hospital Cardiac Arrest Related to Acute Coronary Syndrome: A Literature Review

Gall,

Mafi,

Ghannam

et al. 2023

JCM

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Out-of-hospital cardiac arrest (OHCA) continues to be a major global cause of death, affecting approximately 67 to 170 per 100,000 inhabitants annually in Europe, with a persisting high rate of mortality of up to 90% in most countries. Acute coronary syndrome (ACS) represents one of the most significant cause of cardiac arrest, and therefore invasive coronary angiography (CAG) with subsequent percutaneous coronary intervention (PCI) has emerged as a fundamental component in the management of OHCA patients. Recent evidence from large randomized controlled trials (RCTs) challenges the routine use of early CAG in the larger subgroup of patients with non-ST segment elevation myocardial infarction (NSTEMI). Additionally, emerging data suggest that individuals resuscitated from OHCA related to ACS face an elevated risk of thrombotic and bleeding events. Thus, specific invasive coronary strategies and anti-thrombotic therapies tailored to this unique setting of OHCA need to be considered for optimal in-hospital management. We sought to provide an overview of the prevalence and complexity of coronary artery disease observed in this specific population, discuss the rationale and timing for CAG after return of spontaneous circulation (ROSC), summarize invasive coronary strategies, and examine recent findings on antithrombotic therapies in the setting of ACS complicated by OHCA. By synthesizing the existing knowledge, this review aims to contribute to the understanding and optimization of care for OHCA patients to improve outcomes in this challenging clinical scenario.

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“…There have also been concerns for possible delay of optimal intensive care support including temperature control. And also, skepticism about the use of resource-intensive diagnostic and therapeutic modalities such as CAG with PCI, in comatose patients that might eventually die of irreversible neurological damage [17,18 ▪ ]. Currently, none of the available prognostic instruments [19–21] for early prognostication of these patients has gained universal acceptability as an aid to treatment decisions for these patients [20,22 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Coronary angiography after cardiac arrest

Νικολάου

2023

Current Opinion in Critical Care

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Purpose of reviewAcute coronary syndromes represent the commonest cause of out-of-hospital cardiac arrest (OHCA) in adults. Coronary angiography (CAG) followed by percutaneous coronary intervention (PCI) has been established as the treatment strategy for these patients. In this review, we aim first to discuss the potential risks and expected benefits from it, the caveats in its implementation, and the current tools for patient selection. Then summarize the recent evidence on the group of patients without ST-segment elevation on post-return of spontaneous circulation (ROSC) ECG. Recent findingsThe implementation of this strategy still shows a wide variation among the various systems of care. The presence of ST-segment elevation on post-ROSC ECG remains the most reliable tool for patient selection for immediate CAG. A primary PCI strategy is currently recommended for patients with ST-segment elevation on post-ROSC ECG regardless of the conscious state of patients. Recently several randomised studies including patients without ST-segment elevation on post-ROSC ECG showed no benefit with immediate CAG compared to delayed/ elective CAG. This has led to a substantial although not uniform change in current recommendations.

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Immediate coronary angiogram in out-of-hospital cardiac arrest patients with non-shockable initial rhythm and without ST-segment elevation — Is there a clinical benefit?

Cited by 8 publications

References 29 publications

Application of the TiPS65 score for out-of-hospital cardiac arrest patients with initial non-shockable rhythm treated with ECPR

Application of the TiPS65 score for out-of-hospital cardiac arrest patients with initial non-shockable rhythm treated with ECPR

Percutaneous Coronary Intervention in Out-of-Hospital Cardiac Arrest Related to Acute Coronary Syndrome: A Literature Review

Coronary angiography after cardiac arrest

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