Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest.
Long-term survival rates even after successful resuscitation from out-of-hospital cardiac arrest are dismal. Most of those initially resuscitated expired during their hospitalization. Recent reports have suggested that a more aggressive approach to postresuscitation care is the key to better outcome. Waiting for the evidence of neurological recovery before acting can result in missed opportunity to improve such recovery. Immediate induction of mild therapeutic hypothermia for all resuscitated victims who remain comatose offers the best hope for neurological recovery. Numerous reports suggest that early coronary angiography and PCI also improve outcome among those resuscitated from cardiac arrest whose postresuscitation ECG show evidence of ST elevation myocardial infarctions. Most promising is combining these two postresuscitation therapies, namely immediate induction of hypothermia and early coronary angiography and PCI. Combining these therapies has resulted in long-term survival rates of 70% with more than 80% of all such survivors neurologically functional. Even those without ST elevation on their postresuscitation ECG can greatly benefit from timely induction of hypothermia and early angiography/PCI.
Kern
Karl B
KB
Sarver Heart Center at the University of Arizona College of Medicine, Tucson, Arizona 85724, USA. kernk@email.arizona.edu
Rahman
Ossama
O
D000328:Adult; D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods; D003128:Coma / Q000209:etiology / Q000628:therapy; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D047548:Defibrillators; D004554:Electric Countershock / Q000295:instrumentation; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D013997:Time Factors; D016896:Treatment Outcome