Post-resuscitation electrocardiograms, acute coronary findings and in-hospital prognosis of survivors of out-of-hospital cardiac arrest

Garcı́a-Tejada, Julio; Jurado-Román, Alfonso; Rodríguez, Jorge; Velázquez, Maite; Hernández, Felipe; Albarrán, Agustín; Martín‐Asenjo, Roberto; Granda-Nistal, Carolina; Coma, Raúl; Tascón, Juan

doi:10.1016/j.resuscitation.2014.06.001

Cited by 47 publications

(29 citation statements)

References 25 publications

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“…Nevertheless, the reported incidences of AMI are 36-61% [8,[15][16][17][18][19], which is similar to our finding. In this study, we diagnosed AMI exclusively based on CAG findings, because clinical and ECG findings are poor predictors of AMI in OHCA [15][16][17][18][19][20], and troponin levels can be elevated in patients with OHCA (even those without AMI) [21]. Interestingly, epidemiologic data indicate that DCM and HCM are the second most common causes of sudden cardiac death (10-15%), and other cardiac disorders (e.g.…”

Section: Causes Of Cpasupporting

confidence: 92%

“…Among the 125 included cases, the causes of CPA were cardiac-related in 109 patients [87%, including 66 (53%) AMI cases]; the exceptions were aortic dissection (2 patients), accidental hypothermia (2 patients), and unknown etiologies (12 patients). However, the results of this study cannot be easily compared to those of previous reports, because the previous studies had patient populations that were limited to patients with refractory shockable cardiac rhythm [8] or not exclusively limited to patients with shockable initial cardiac rhythm [15][16][17][18][19]. Nevertheless, the reported incidences of AMI are 36-61% [8,[15][16][17][18][19], which is similar to our finding.…”

Section: Causes Of Cpasupporting

confidence: 74%

“…However, the results of this study cannot be easily compared to those of previous reports, because the previous studies had patient populations that were limited to patients with refractory shockable cardiac rhythm [8] or not exclusively limited to patients with shockable initial cardiac rhythm [15][16][17][18][19]. Nevertheless, the reported incidences of AMI are 36-61% [8,[15][16][17][18][19], which is similar to our finding. In this study, we diagnosed AMI exclusively based on CAG findings, because clinical and ECG findings are poor predictors of AMI in OHCA [15][16][17][18][19][20], and troponin levels can be elevated in patients with OHCA (even those without AMI) [21].…”

Section: Causes Of Cpasupporting

confidence: 74%

“…Therefore, our findings may explain that ventricular fibrillation after recanalization is easier to achieve ROSC than ventricular fibrillation after coronary artery occlusion. [15,16]. Nevertheless, these studies are difficult to compare, given the differences in study population (e.g.…”

Section: The Resistance Factors For Conventional Cpr In Ohcamentioning

confidence: 99%

See 3 more Smart Citations

Resistance to conventional cardiopulmonary resuscitation in witnessed out-of-hospital cardiac arrest patients with shockable initial cardiac rhythm

Otani

Sawano

Oyama

et al. 2016

Journal of Cardiology

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Section: Causes Of Cpasupporting

confidence: 92%

Section: Causes Of Cpasupporting

confidence: 74%

Section: Causes Of Cpasupporting

confidence: 74%

Section: The Resistance Factors For Conventional Cpr In Ohcamentioning

confidence: 99%

See 2 more Smart Citations

Resistance to conventional cardiopulmonary resuscitation in witnessed out-of-hospital cardiac arrest patients with shockable initial cardiac rhythm

Otani

Sawano

Oyama

et al. 2016

Journal of Cardiology

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show abstract

“…In patients with ST-segment elevation or left bundle branch block on initial ECG after ROSC, the prevalence of an acute coronary lesion is more than 80%. 58 Many observational studies indicate that percutaneous coronary intervention (PCI) improves survival or neurologic outcome. 59,60 Some observational studies have also demonstrated better survival and functional outcome after ROSC achieved with a combination of TTM and PCI for STelevation myocardial infarction (STEMI).…”

Section: Cbf and Metabolismmentioning

confidence: 99%

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima

Hifumi

Kawakita

et al. 2017

Circ J

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The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.

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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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Post-resuscitation electrocardiograms, acute coronary findings and in-hospital prognosis of survivors of out-of-hospital cardiac arrest

Cited by 47 publications

References 25 publications

Resistance to conventional cardiopulmonary resuscitation in witnessed out-of-hospital cardiac arrest patients with shockable initial cardiac rhythm

Resistance to conventional cardiopulmonary resuscitation in witnessed out-of-hospital cardiac arrest patients with shockable initial cardiac rhythm

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

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

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