Invasive Management of Out of Hospital Cardiac Arrest

Abstract

Out of hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality worldwide. Clinical decision making is extremely difficult in this understudied patient population with high prevalence of neurological injury and inexorable shock states. As such, there are uncertain benefits from therapies available in the cardiac catheterization laboratory. Fear of futility and public reporting often affects decision making and can result in risk aversion. This review focuses on invasive management in OHCA care, with particular focus on coronary angiography, coronary revascularization, and mechanical support. Guidelines recommend emergency coronary angiography in patients with ST-segment elevations on ECG after OHCA, while the role of coronary angiography in patients without ST-segment elevations is less clear. Similar uncertainty remains in the appropriate revascularization strategy in these patients. As in other areas of cardiology, there is a growing interest in the role of mechanical circulatory support after OHCA, though the available literature shows mixed results. The many uncertainties associated with treating the patient with OHCA highlight the importance of clinical decision support tools and treatment algorithms in the care of this population. This review focuses on invasive management in OHCA care, with particular focus on coronary angiography, coronary revascularization, and mechanical support.

Metabolic Syndrome, Gamma-Glutamyl Transferase, and Risk of Sudden Cardiac Death

“…Sudden cardiac death (SCD) is an emergent medical condition that requires timely intervention to bring the victim back to life [ 1 , 2 ]. However, since all SCD cases occur outside the hospital, immediate professional intervention is virtually impossible [ 2 , 3 , 4 , 5 ]. The SCD survival rates are still not satisfactory, even in the most developed regions of the world, whereas neurologically intact survival rates are even lower [ 6 , 7 ].…”

“…The underlying causes of SCD include coronary artery disease, primary myocardial or electrical disorders such as hypertrophic cardiomyopathy and Brugada syndrome, and valvular heart disease [ 3 , 8 ]. Metabolic syndrome, which is characterized by abdominal obesity, dyslipidemia, an elevated fasting glucose, and high blood pressure, is an established risk factor for coronary artery disease and SCD [ 9 , 10 ].…”

Clinical features and predictors of outcome in patients with acute myocardial infarction complicated by out-of-hospital cardiac arrest

“…PCPS was used aggressively in patients who could not be resuscitated successfully. Several studies have shown the benefit of extracorporeal cardiopulmonary resuscitation (CPR) in CA patients [ 20 ].…”

External validation of the Survival After ROSC in Cardiac Arrest (SARICA) score for predicting survival after return of spontaneous circulation using multinational pan-asian cohorts

“…While the pooled incidence of return of spontaneous circulation (ROSC) is 29.7%, only 8.8% achieved 30-day survival globally ( 3 ) and 5.8% in the Asia Pacific ( 4 ). Advanced interventions post-ROSC can improve mortality in well-selected patients, ( 5 ) but also come with significant costs estimated at USD 333,844 per person ( 6 ).…”