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Pareek N, Kordis P, Webb I, Noc M, MacCarthy P, Byrne J. Contemporary Management of Out-of-hospital Cardiac Arrest in the Cardiac Catheterisation Laboratory: Current Status and Future Directions. Interv Cardiol 2019; 14:113-123. [PMID: 31867056 PMCID: PMC6918505 DOI: 10.15420/icr.2019.3.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and morbidity in developed countries and remains an important public health burden. A primary cardiac aetiology is common in OHCA patients, and so patients are increasingly brought to specialist cardiac centres for consideration of coronary angiography, percutaneous coronary intervention and mechanical circulatory support. This article focuses on the management of OHCA in the cardiac catheterisation laboratory. In particular, it addresses conveyance of the OHCA patient direct to a specialist centre, the role of targeted temperature management, pharmacological considerations, provision of early coronary angiography and mechanical circulatory support.
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Affiliation(s)
- Nilesh Pareek
- King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
| | | | - Ian Webb
- King’s College Hospital NHS Foundation TrustLondon, UK
| | - Marko Noc
- University Medical CentreLjubljana, Slovenia
| | - Philip MacCarthy
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
| | - Jonathan Byrne
- King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
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Hiemstra B, Bergman R, Absalom AR, van der Naalt J, van der Harst P, de Vos R, Nieuwland W, Nijsten MW, van der Horst ICC. Long-term outcome of elderly out-of-hospital cardiac arrest survivors as compared with their younger counterparts and the general population. Ther Adv Cardiovasc Dis 2018; 12:341-349. [PMID: 30231773 PMCID: PMC6266245 DOI: 10.1177/1753944718792420] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND: Over the past decade, prehospital and in-hospital treatment for out-of-hospital cardiac arrest (OHCA) has improved considerably. There are sparse data on the long-term outcome, especially in elderly patients. We studied whether elderly patients benefit to the same extent compared with younger patients and at long-term follow up as compared with the general population. METHODS: Between 2001 and 2010, data from all patients presented to our hospital after OHCA were recorded. Elderly patients (⩾75 years) were compared with younger patients. Neurological outcome was classified as cerebral performance category (CPC) at hospital discharge and long-term survival was compared with younger patients and predicted survival rates of the general population. RESULTS: Of the 810 patients admitted after OHCA, a total of 551 patients (68%) achieved return of spontaneous circulation, including 125 (23%) elderly patients with a mean age of 81 ± 5 years. In-hospital survival was lower in elderly patients compared with younger patients with rates of 33% versus 57% ( p < 0.001). A CPC of 1 was present in 73% of the elderly patients versus 86% of the younger patients ( p = 0.031). In 7.3% of the elderly patients, a CPC >2 was observed versus 2.5% of their younger counterparts ( p = 0.103). Elderly patients had a median survival of 6.5 [95% confidence interval (CI) 2.0-7.9] years compared with 7.7 (95% CI 7.5-7.9) years of the general population ( p = 0.019). CONCLUSIONS: The survival rate after OHCA in elderly patients is approximately half that of younger patients. Elderly patients who survive to discharge frequently have favorable neurological outcomes and a long-term survival that approximates that of the general population.
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Affiliation(s)
- Bart Hiemstra
- Department of Critical Care, University of
Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001,
Groningen, 9700 RB, The Netherlands
| | - Remco Bergman
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Anthony R. Absalom
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Ronald de Vos
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Wybe Nieuwland
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
| | - Maarten W. Nijsten
- University of Groningen, University Medical
Center Groningen, Groningen, The Netherlands
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Abstract
The prognosis after out-of-hospital cardiac arrest (OHCA) has improved in the past few decades because of advances in interventions used outside and in hospital. About half of patients who have OHCA with initial ventricular tachycardia or ventricular fibrillation and who are admitted to hospital in coma after return of spontaneous circulation will survive to discharge with a reasonable neurological status. In this Series paper we discuss in-hospital management of patients with post-cardiac-arrest syndrome. In most patients, the most important in-hospital interventions other than routine intensive care are continuous active treatment (in non-comatose and comatose patients and including circulatory support in selected patients), cooling of core temperature to 32-36°C by targeted temperature management for at least 24 h, immediate coronary angiography with or without percutaneous coronary intervention, and delay of final prognosis until at least 72 h after OHCA. Prognosis should be based on clinical observations and multimodal testing, with focus on no residual sedation.
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Affiliation(s)
- Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Ken Nagao
- Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton and Hove, UK
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Shavelle DM, Bosson N, Thomas JL, Kaji AH, Sung G, French WJ, Niemann JT. Outcomes of ST Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest (from the Los Angeles County Regional System). Am J Cardiol 2017; 120:729-733. [PMID: 28728743 DOI: 10.1016/j.amjcard.2017.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/16/2017] [Accepted: 06/01/2017] [Indexed: 01/01/2023]
Abstract
The objective of this study was to evaluate the time to primary percutaneous coronary intervention (PCI) and the outcome for patients with ST elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA). In this regional system, all patients with STEMI and/or OHCA with return of spontaneous circulation were transported to STEMI Receiving Centers. The outcomes registry was queried for patients with STEMI with underwent primary PCI from April 2011 to December 2014. Patients with STEMI complicated by OHCA were compared with a reference group of STEMI without OHCA. The primary end point was the first medical contact-to-device time. Of 4,729 patients with STEMI who underwent primary PCI, 422 patients (9%) suffered OHCA. Patients with OHCA were on average 2 years (95% confidence interval 0.7 to 3.0) older and had a slightly higher male predominance. The first medical contact-to-device time was longer in STEMI with OHCA compared with STEMI alone (94 ± 37 vs. 86 ± 34 minutes, p < 0.0001). In-hospital mortality was higher after OHCA, 38% versus 6% in STEMI alone, odds ratio 6.3 (95% confidence interval 5.3 to 7.4). Among OHCA survivors, 193 (73%) were discharged with a cerebral performance category score of 1 or 2. In conclusion, despite longer treatment intervals, neurologic outcome was good in nearly half of the surviving patients with STEMI complicated by OHCA, suggesting that these patients can be effectively treated with primary PCI in a regionalized system of care.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California.
| | - Nichole Bosson
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California; Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joseph L Thomas
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of Cardiology, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Gene Sung
- Department of Neurology, University of Southern California, Los Angeles, California
| | - William J French
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of Cardiology, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California
| | - James T Niemann
- Department of Emergency Medicine, Harbor-UCLA Medical Centre and the Los Angeles Biomedical Institute, Torrance, California; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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The association of maximum Troponin values post out-of-hospital cardiac arrest with electrocardiographic findings, cardiac reperfusion procedures and survival to discharge: A sub-study of ROC PRIMED. Resuscitation 2016; 111:82-89. [PMID: 27988273 DOI: 10.1016/j.resuscitation.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The role of Troponin (Tn) levels in the management of patients post out-of-hospital cardiac arrest (OHCA) is unclear. METHODS All OHCA patients enrolled in the Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed analysis trial and admitted to hospital with a Tn level and a 12-lead electrocardiogram were stratified by ST elevation (STE) or no STE in a regression model for survival to discharge adjusted for Utstein predictors and site. RESULTS Of the 15,617 enrolled OHCA patients, 4118 (26%) survived to admission to hospital; 17% (693) were STE and 77% (3188) were no STE with 6% unknown; 83% (3460) had at least one Tn level. Reperfusion rates were higher when Tn level >2ng/ml (p>0.1ng/ml) improved with a diagnostic cardiac catheterization (p<0.001). CONCLUSIONS Elevated Tn levels >2ng/ml were associated with improved survival to discharge in patients post OHCA with STE. Survival in patients with no STE and Tn values >0.1ng/ml was higher when associated with diagnostic cardiac catheterization or treated with reperfusion or revascularization.
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Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients Undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry). Cardiol Res Pract 2016; 2016:8798261. [PMID: 26885436 PMCID: PMC4739452 DOI: 10.1155/2016/8798261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/22/2015] [Accepted: 12/16/2015] [Indexed: 02/03/2023] Open
Abstract
Objective. Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with high mortality. Combining mild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design. A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results. The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In the MTH + C and MTH + NC groups, the in-hospital mortality was 48% and 78%, respectively. The only independent predictor of in-hospital mortality for patients with MTH + C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8–47.1, and p = 0.009). Conclusion. Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.
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Rab T, Kern KB, Tamis-Holland JE, Henry TD, McDaniel M, Dickert NW, Cigarroa JE, Keadey M, Ramee S. Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient. J Am Coll Cardiol 2015; 66:62-73. [PMID: 26139060 DOI: 10.1016/j.jacc.2015.05.009] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/28/2015] [Accepted: 05/05/2015] [Indexed: 12/14/2022]
Abstract
Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory.
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Affiliation(s)
- Tanveer Rab
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Karl B Kern
- Sarver Heart Center, University of Arizona, Tucson, Arizona
| | | | - Timothy D Henry
- Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Michael McDaniel
- Division of Cardiology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Neal W Dickert
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Matthew Keadey
- Division of Emergency Medicine, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen Ramee
- Structural and Valvular Heart Disease Program, Ochsner Medical Center, New Orleans, Louisiana
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9
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Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: Review and meta-analysis. Resuscitation 2014; 85:1533-40. [DOI: 10.1016/j.resuscitation.2014.08.025] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/03/2014] [Accepted: 08/16/2014] [Indexed: 12/16/2022]
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10
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Gorjup V, Noc M, Radsel P. Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction. World J Cardiol 2014; 6:444-448. [PMID: 24976916 PMCID: PMC4072834 DOI: 10.4330/wjc.v6.i6.444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/07/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention (PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion (“ACS” lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is present.
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Ariza Solé A, Salazar-Mendiguchía J, Lorente-Tordera V, Sánchez-Salado JC, González-Costello J, Moliner-Borja P, Gómez-Hospital JA, Manito-Lorite N, Cequier-Fillat A. Invasive mechanical ventilation in acute coronary syndromes in the era of percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 2:109-17. [PMID: 24222819 DOI: 10.1177/2048872613484686] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 03/11/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) improves prognosis in patients with acute coronary syndromes (ACS) reducing ischaemic complications and the development of heart failure, thus potentially changing invasive mechanical ventilation (IMV) requirements. Little information exists about patients with ACS requiring IMV in the current era. We aimed to analyze IMV requirements and characteristics of ACS patients treated under current recommendations (including a high rate of PCI). METHODS Baseline characteristics, indications for IMV, management and in-hospital and mid-term clinical course were analyzed prospectively in a consecutive series of patients with ACS admitted to a tertiary care hospital. RESULTS We included 1821 patients, of which 106 (5.8%) required IMV. Mean follow-up was 347 days. PCI was performed in 84% of cases. Patients with IMV had more comorbidities, worse left ventricular function and more unstable hemodynamic parameters on admission. In-hospital mortality in patients requiring IMV was 29%. These patients also had higher mid-term mortality (hazard ratio (HR) 6.58; 95% confidence interval (CI) 4.49-9.64; p 0.001). The most common indication for IMV was cardiopulmonary arrest (CA) (65; 61%), followed by pulmonary oedema (27; 26%) and shock (14; 13.2%). Patients with CA were younger, with better hemodynamic parameters at admission, more favourable coronary anatomy and higher rates of PCI. There were no significant differences in overall mortality between the three groups. The main cause of death in CA patients was persistent vegetative state. CONCLUSIONS Mortality in patients with ACS requiring IMV remained high despite a high rate of PCI. Baseline characteristics, management and clinical course were different according to the reason for IMV. The most common cause for IMV requirement was CA.
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Kunadian V, Bawamia B, Maznyczka A, Zaman A, Qiu W. Outcomes following primary percutaneous coronary intervention in the setting of cardiac arrest: a registry database study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:6-15. [PMID: 24818951 DOI: 10.1177/2048872614534079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The mortality rate among patients undergoing primary percutaneous coronary intervention (PPCI) in the setting of cardiac arrest (CA) and whether the location where the patient sustains CA influences the outcome is not known in the contemporary era. METHODS Prospectively collected data at a tertiary cardiac centre on all patients undergoing PPCI for ST elevation myocardial infarction (STEMI) in the setting of CA was analysed. RESULTS In total, 484/4118 (11.8%) patients sustained CA during the study period. Of these, 91/484 (18.8%) sustained CA prior to ambulance arrival, the remainder occurred either after ambulance arrival or in hospital. The overall in-hospital mortality was 20.5% in this cohort. Those sustaining CA before ambulance arrival experienced the highest unadjusted mortality compared to those that had CA after ambulance arrival, in hospital and in the catheterisation laboratory (29.7% versus 12.0%, 16.1% and 23.8% respectively, p=0.03). Multiple logistic regression analysis showed that the following parameters are independent predictors of in-hospital mortality: age (odds ratio (OR) for each year increment of age 1.05; 95% confidence interval (CI) 1.02-1.08, p=0.0009); female gender (OR 2.42; 95% CI 1.17-4.99, p=0.0173); previous PCI (OR 7.59; 95% CI 1.72-33.53, p=0.0075); asystole/ electromechanical dissociation (EMD) (OR 13.43; 95% CI 5.34-33.80, p<0.0001); and patient location at arrest (OR 5.77 for before ambulance arrival; 95% CI 2.55-13.07, p<0.0001). CONCLUSIONS In conclusion, in-hospital mortality remains high among patients undergoing PPCI in the context of CA, particularly among those that arrest prior to ambulance arrival.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University, UK Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Bilal Bawamia
- Institute of Cellular Medicine, Newcastle University, UK Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Annette Maznyczka
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Azfar Zaman
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Weiliang Qiu
- Channing Division of Network Medicine, Brigham and Women's Hospital/Harvard Medical School, USA
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Noc M, Fajadet J, Lassen JF, Kala P, MacCarthy P, Olivecrona GK, Windecker S, Spaulding C. Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups. EUROINTERVENTION 2014; 10:31-7. [DOI: 10.4244/eijv10i1a7] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lim HS, Stub D, Ajani AE, Andrianopoulos N, Reid CM, Charter K, Black A, Smith K, New G, Chan W, Lim CC, Farouque O, Shaw J, Brennan A, Duffy SJ, Clark DJ. Survival in patients with myocardial infarction complicated by out-of-hospital cardiac arrest undergoing emergency percutaneous coronary intervention. Int J Cardiol 2013; 166:425-30. [DOI: 10.1016/j.ijcard.2011.10.131] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/27/2011] [Accepted: 10/29/2011] [Indexed: 10/14/2022]
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Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest--a systematic review and meta-analysis. Resuscitation 2012; 83:1427-33. [PMID: 22960567 DOI: 10.1016/j.resuscitation.2012.08.337] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/30/2012] [Accepted: 08/30/2012] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Out-of-hospital cardiac arrest has a poor prognosis. The main aetiology is ischaemic heart disease. AIM To make a systematic review addressing the question: "In patients with return of spontaneous circulation following out-of-hospital cardiac arrest, does acute coronary angiography with coronary intervention improve survival compared to conventional treatment?" METHODS Peer reviewed articles written in English with relevant prognostic data were included. Comparison studies on patients with and without acute coronary angiography were pooled in a meta-analysis. RESULTS Thirty-two non-randomised studies were included of which 22 were case-series without patients with conservative treatment. Seven studies with specific efforts to control confounding had statistical evidence to support the use of acute coronary angiography following resuscitation from out-of-hospital cardiac arrest. The remaining 25 studies were considered neutral. Following acute coronary angiography, the survival to hospital discharge, 30 days or six months ranged from 23% to 86%. In patients without an obvious non-cardiac aetiology, the prevalence of significant coronary artery disease ranged from 59% to 71%. Electrocardiographic findings were unreliable for identifying angiographic findings of acute coronary syndrome. Ten comparison studies demonstrated a pooled unadjusted odds ratio for survival of 2.78 (1.89; 4.10) favouring acute coronary angiography. CONCLUSION No randomised studies exist on acute coronary angiography following out-of-hospital cardiac arrest. An increasing number of observational studies support feasibility and a possible survival benefit of an early invasive approach. In patients without an obvious non-cardiac aetiology, acute coronary angiography should be strongly considered irrespective of electrocardiographic findings due to a high prevalence of coronary artery disease.
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Arntz HR. Routinemäßige sofortige Koronarographie/PCI. Notf Rett Med 2012. [DOI: 10.1007/s10049-011-1570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Acute angiography for all resuscitated patients upon hospital admission. Notf Rett Med 2012. [DOI: 10.1007/s10049-011-1569-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kern KB. Optimal Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. JACC Cardiovasc Interv 2012; 5:597-605. [DOI: 10.1016/j.jcin.2012.01.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 01/11/2012] [Accepted: 01/20/2012] [Indexed: 11/26/2022]
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Kern KB. Importance of invasive interventional strategies in resuscitated patients following sudden cardiac arrest. Interv Cardiol 2011. [DOI: 10.2217/ica.11.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Immediate angiography for everyone after cardiac arrest? How can we find the patients who will not benefit? Resuscitation 2011; 82:1118-9. [DOI: 10.1016/j.resuscitation.2011.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 05/29/2011] [Indexed: 11/17/2022]
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Encouraging (Not Discouraging) Optimal Care for All ST-Segment Elevation Myocardial Infarction Patients. JACC Cardiovasc Interv 2011; 4:449-51. [DOI: 10.1016/j.jcin.2011.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 02/11/2011] [Indexed: 02/04/2023]
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Vanden Hoek TL, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S422-65. [PMID: 20956257 DOI: 10.1161/circulationaha.110.985549] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, Gabrielli A, Silvers SM, Zaritsky AL, Merchant R, Vanden Hoek TL, Kronick SL. Part 9: Post–Cardiac Arrest Care. Circulation 2010; 122:S768-86. [DOI: 10.1161/circulationaha.110.971002] [Citation(s) in RCA: 957] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kern KB, Rahman O. Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest. Catheter Cardiovasc Interv 2010; 75:616-24. [PMID: 20049976 DOI: 10.1002/ccd.22192] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Long-term survival rates even after successful resuscitation from out-of-hospital cardiac arrest are dismal. Most of those initially resuscitated expired during their hospitalization. Recent reports have suggested that a more aggressive approach to postresuscitation care is the key to better outcome. Waiting for the evidence of neurological recovery before acting can result in missed opportunity to improve such recovery. Immediate induction of mild therapeutic hypothermia for all resuscitated victims who remain comatose offers the best hope for neurological recovery. Numerous reports suggest that early coronary angiography and PCI also improve outcome among those resuscitated from cardiac arrest whose postresuscitation ECG show evidence of ST elevation myocardial infarctions. Most promising is combining these two postresuscitation therapies, namely immediate induction of hypothermia and early coronary angiography and PCI. Combining these therapies has resulted in long-term survival rates of 70% with more than 80% of all such survivors neurologically functional. Even those without ST elevation on their postresuscitation ECG can greatly benefit from timely induction of hypothermia and early angiography/PCI.
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Affiliation(s)
- Karl B Kern
- Sarver Heart Center at the University of Arizona College of Medicine, Tucson, Arizona 85724, USA.
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Callaway CW, Schmicker R, Kampmeyer M, Powell J, Rea TD, Daya MR, Aufderheide TP, Davis DP, Rittenberger JC, Idris AH, Nichol G. Receiving hospital characteristics associated with survival after out-of-hospital cardiac arrest. Resuscitation 2010; 81:524-9. [PMID: 20071070 DOI: 10.1016/j.resuscitation.2009.12.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 02/03/2023]
Abstract
AIM Survival after out-of-hospital cardiac arrest (OOHCA) varies between regions, but the contribution of different factors to this variability is unknown. This study examined whether survival to hospital discharge was related to receiving hospital characteristics, including bed number, capability of performing cardiac catheterization and hospital volume of OOHCA cases. MATERIAL AND METHODS Prospective observational database of non-traumatic OOHCA assessed by emergency medical services was created in 8 US and 2 Canadian sites from December 1, 2005 to July 1, 2007. Subjects received hospital care after OOHCA, defined as either (1) arriving at hospital with pulses, or (2) arriving at hospital without pulses, but discharged or died > or =1 day later. RESULTS A total of 4087 OOHCA subjects were treated at 254 hospitals, and 32% survived to hospital discharge. A majority of subjects (68%) were treated at 116 (46%) hospitals capable of cardiac catheterization. Unadjusted survival to discharge was greater in hospitals performing cardiac catheterization (34% vs. 27%, p=0.001), and in hospitals that received > or =40 patients/year compared to those that received <40 (37% vs. 30%, p=0.01). Survival was not associated with hospital bed number, teaching status or trauma center designation. Length of stay (LOS) for surviving subjects was shorter at hospitals performing cardiac catheterization (p<0.01). After adjusting for all variables, there were no independent associations between survival or LOS and hospital characteristics. CONCLUSIONS Some subsets of hospitals displayed higher survival and shorter LOS for OOHCA subjects but there was no independent association between hospital characteristics and outcome.
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Affiliation(s)
- Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Vorgehen bei STEMI/NSTEMI nach Reanimation. Notf Rett Med 2008. [DOI: 10.1007/s10049-008-1069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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