Abstract
Out-of-hospital cardiac arrest (OHCA) is still associated with high mortality and severe complications, despite major treatment advances in this field. Ischemic heart disease is a common cause of OHCA, and current guidelines clearly recommend performing immediate coronary angiography (CAG) in patients whose post-resuscitation electrocardiogram shows ST-segment elevation (STE). Contrarily, the optimal approach and the advantage of early revascularization in cases of no STE is less clear, and decisions are often based on the individual experience of the center. Numerous studies have been conducted on this topic and have provided contradictory evidence; however, more recently, results from several randomized clinical trials have suggested that performing early CAG has no impact on overall survival in patients without STE.
Highlights
Despite advances in percutaneous coronary revascularization and intensive care unit (ICU) management, out-of-hospital cardiac arrest (OHCA) remains associated with high mortality and severe neurological complications [1]
After Cardiac Arrest (HACA) working group documented that the use of therapeutic hypothermia (TH), in patients with OHCA due to ventricular fibrillation, was associated with clinically significant neurological improvement and a 14% improvement in survival 6 months after resuscitation, compared with the control group without hypothermia induction (59% vs. 45%, p < 0.02) [5]
The presented cases demonstrate how, in daily practice, indications to perform immediate coronary angiography (CAG) are often based on individual decisions, and that clear guidelines are still missing
Summary
Despite advances in percutaneous coronary revascularization and intensive care unit (ICU) management, out-of-hospital cardiac arrest (OHCA) remains associated with high mortality and severe neurological complications [1]. After Cardiac Arrest (HACA) working group documented that the use of TH, in patients with OHCA due to ventricular fibrillation, was associated with clinically significant neurological improvement and a 14% improvement in survival 6 months after resuscitation, compared with the control group without hypothermia induction (59% vs 45%, p < 0.02) [5]. It is controversial whether TH might trigger infectious complications through a pro-inflammatory effect (including sepsis) or by creating a “sepsis-like” syndrome via an increase in pro-inflammatory cytokines, including interleukin (IL)-1β, IL-8, and tumor necrosis factor (TNF)-α [6]. Patients without STE following a cardiac arrest had an acute coronary occlusion at the CAG, with reported prevalence varying from 17 to 33% [9,16,17]
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