title: Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient.
abstract: Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory.
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: srab@emory.edu.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Rab
authors.affiliation: Sarver Heart Center, University of Arizona, Tucson, Arizona.
authors.forename: Karl B
authors.initials: KB
authors.lastname: Kern
authors.affiliation: Icahn School of Medicine, Mount Sinai Saint Luke's Hospital, New York, New York.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tamis-Holland
authors.affiliation: Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.affiliation: Division of Cardiology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael
authors.initials: M
authors.lastname: McDaniel
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Neal W
authors.initials: NW
authors.lastname: Dickert
authors.affiliation: Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon.
authors.forename: Joaquin E
authors.initials: JE
authors.lastname: Cigarroa
authors.affiliation: Division of Emergency Medicine, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Keadey
authors.affiliation: Structural and Valvular Heart Disease Program, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Stephen
authors.initials: S
authors.lastname: Ramee
mesh_terms: D000465:Algorithms; D016887:Cardiopulmonary Resuscitation; D003128:Coma; D017023:Coronary Angiography / Q000941:ethics; D003661:Decision Support Techniques; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000941:ethics; D011379:Prognosis
keywords: cardiac catheterization; out-of-hospital cardiac arrest; percutaneous coronary intervention; risk stratification