Abstract 95: Coronary Intervention After Out-of-Hospital Cardiopulmonary Resuscitation: Chances and Limitations

Abstract

Background: Actual guidelines recommend an invasive approach (CORO) in case an ischemic cause of sudden cardiac arrest (SCD) can`t be excluded. Methods: In a retrospective study we investigated procedures and course of 767 consecutive OHCA pts. of whom 220 pts who survived to hospital admission and 166 were admitted to our hospital. Results: CORO was performed in 91 pts. Of these 83 had a prehospital ECG or an ECG at admission: Thirty-nine (47%) of the pts with CORO had typical ECG signs of a STEMI (SECG), 44 pts had CORO without a SECG. On the other side 52 of 58 (89%) pts without CORO had not a typical SECG. A “culprit lesion” was detected in 30 of 39 (70%) of pts with an SECG but also in 21 of 44 (46%) pts without an SECG. Creatinine levels a admission were elevated in pts with CORO (1.4 mg/l) as well as in pts without CORO (1.8 mg/l). During hospital stay hemodialysis/CVVH was considered necessary in 28 of 91 pts (31%) with CORO and 21 of 75 pts (28%) without CORO (p=ns). We did not observe a selection bias concerning admission of pts to our hospital or other hospitals respectively. With regard to perform CORO, however, there was a significant tendency to preference of prognostic favorable groups i.e. younger pts <65years (p=0.042), pts with VF/VT as initial rhythm (p<0.01) and a trend to pts with bystander resuscitation. With CORO survived 42 of 55 pts (76%) with a CPC score of 1 or 2 and 22 of 32 pts (69%) with a CPC score of 3 or 4. Twenty-seven of the 91 pts (36%) with CORO and 48 of the 71 pts (67%) without CORO died (p<0.001). Conclusion: Intervention is principally justified in resuscitated pts in whom an ischemic cause has to be assumed. Without a randomized prospective study, however, it will remain unclear, to which extend CORO improves prognosis after CPR or if CORO is only an “add-on” of minor relevance in a group of pts with a basically good prognosis.