A Routine Invasive Strategy for Out-of-Hospital Cardiac Arrest Survivors

Abstract

Out-of-hospital cardiac arrest (OHCA) is estimated to afflict approximately 236 000 to 325 000 people in the United States annually,1 with wide regional1 and interhospital2 variation in the survival to discharge rates. The prospective, multicenter registry of OHCA in 8 US and 3 Canadian emergency medical service (EMS) agencies and receiving institutions (ROC Epistry–Cardiac Arrest) serving an area of 21.4 million people reported a survival to discharge rate of a mere 1.1% to 8.1% for all EMS-assessed OHCAs, 3.0% to 16.3% for EMS-treated, and 7.7% to 39.9% for patients who presented with ventricular fibrillation.1 Of note, these reported rates are for all EMS-assessed or EMS-treated OHCA regardless of whether there was return of spontaneous circulation (ROSC) before hospital entry. In patients with ROSC at hospital entry, the survival to discharge rate ranges from 10% to 42%.2,–,7 With the initiation of a community-wide early defibrillation program, White et al8 reported that in patients with ventricular fibrillation and sustained ROSC after defibrillation (only in the field), the survival to discharge rate was a remarkable 87%. Thus, there is wide variation in reported rates of survival depending on the cohort reported and the regional systems of care. There are great opportunities to further improve outcomes in OHCA. In this setting, the role of urgent cardiac catheterization and percutaneous coronary intervention (PCI) is of great interest. Article see p 200 In patients with cardiac arrest (predominantly due to ventricular fibrillation) up to 71% have coronary artery disease and 50% have acute coronary artery occlusion.9,10 Prior studies have shown that in postcardiac arrest patients with ST elevation on ECG, PCI was associated with angiographic success rates of 78% to 95% and overall survival to discharge rates of 44% to 75%.11, …