Post-Resuscitation Care: the Role of Early Percutaneous Coronary Intervention

Abstract

BACKGROUND: The outcome of resuscitated cardiac arrest (CA) patients remains poor, despite current advances in cardiopulmonary resuscitation (CPR). Although the majority of cases are of cardiac origin, the decision to perform percutaneous coronary intervention (PCI) is challenging due to the lack of randomized trials and the uncertainty of the neurological outcome. We sought to review the current evidence of early PCI in patients resuscitated after CA with regard to its feasibility, success and long - term outcome. METHODS & RESULTS: The studies for our review were identified from PubMed and references from relevant studies and review papers. We included 18 studies between 1997 to 2010, reporting adult survivors of cardiac arrest, who underwent PCI. The survival at discharge varied from 38% to 81%, with 34.2% to 71.4% of patients having a favorable neurological outcome. Main independent predictors of survival were the time interval between CA and the start of CPR, the existence of a shockable rhythm, early defibrillation, absence of cardiogenic shock, neurological status on admission, and the implementation of PCI. In some studies, significant coronary lesions amenable to PCI, were also found in cardiac arrest patients without evidence of pre-arrest myocardial infarction. As there is no sensitive marker regarding neurological prognosis and many comatose patients regained full neurological function at follow up, several authors suggest that there should be a low threshold for urgent PCI, even in patients with depressed sensorium. CONCLUSION: PCI improves survival in CA patients with STEMI, and should also be considered in survivors of cardiac arrest of presumed cardiac origin, even in cases with poor neurological status on admission. The role of PCI, its long term effectiveness and feasibility at an organizational level need further research.