Which resuscitated patients benefit from PPCI after out-of-hospital cardiac arrest?

Abstract

Background: Survival of prehospital cardiac arrest remains low and variable. Angiography in cardiac arrest survivors shows a high incidence of ischaemic heart disease and myocardial infarction (MI) which are treated at regional ambulance centres in the UK. Methods: A literature search was performed using the health-care databases, Medline and CINAHL, in order the answer the question: ‘Which resuscitated patients benefit from PPCI after out of hospital cardiac arrest?’. There was a screening process to ensure precise relevance to the research question. Findings: 163 articles were found using Medline and CINAHL. After screening, 11 articles were reviewed in text. The evidence favours the intervention and demonstrates increased survival rates when PPCI is available for patients with cardiac arrest following an MI. The ECG is useful to predict coronary occlusion, but cannot rule it out. Increased journey time to reach a regional PPCI centre appears unlikely to impact negatively upon prognosis. Conclusions: There are currently no randomised controlled trials answering this question, and the evidence that is available is frequently influenced by selection bias. There is a need to identify patients who will not benefit from the intervention so that a clinical decision rule can be developed to guide practice.