REBEL Cast Wee: Early Cardiac Catheterization in OHCA Survivors with Non-STEMI

Background: We know that cardiac arrest is a devastating disease and that it occurs in approximately 400,000 Americans each year. In the few patients who achieve return of spontaneous circulation (ROSC) and survive past the pre-hospital stage, mortality rates range from 50 – 60% depending on which sources you read. Neurologic injury is the primary reason for mortality in cardiac arrest patients who do survive to hospital admission and while therapeutic hypothermia (TH) is now an established and recommended therapy to help improve survival and neurologic outcomes in cardiac arrest survivors, the mortality rate is still high in this population.   Acute coronary syndrome (ACS) accounts for the majority of cases of cardiac arrest in adults and some recent studies have shown that early cardiac catheterization (CC) and immediate percutaneous coronary intervention (PCI) are associated with improved survival following cardiac arrest. However, many of the patients included in these studies had ST-elevation myocardial infarction (STEMI). There is already a Class 1 recommendation for early CC & PCI in the setting of STEMI following cardiac arrest, but the data on early CC in comatose post-arrest patients without STEMI is very limited. Post-resuscitation electrocardiogram (ECG) is often unreliable and lack of ST-elevation has a poor sensitivity for the diagnosis of acute coronary occlusion. Recently the American College of Cardiology/American Heart Association (ACC/AHA) proposed and published a new consensus statement an algorithm to stratify cardiac arrest patients who are comatose for CC activation. As part of this algorithm non-ST elevation myocardial infarction (NSTEMI) was added as an indication for CC activation. So with that introduction today on REBEL Cast we are going to specifically tackle: Topic: Early Cardiac Catheterization in OHCA Survivors with Non-STEMI August 2015 REBEL Cast Wee Podcast Click here for Direct Download of Podcast What They Did: Determine if early CC is associated with improved survival in cardiac arrest patients due to ventricular arrhythmia who have ROSC and comatose when ECG evidence of STEMI is absent Retrospective observational study of a prospectively collected cohort of 754 comatose patients who survived to hospital admission after cardiac arrest Six large tertiary care medical centers in the United States Two groups: Early Cardiac Catheterization No Early Cardiac Catheterization Inclusion: All patients ≥18 year so age who survived to hospitalization in a comatose state following cardiac arrest due to ventricular tachycardia/ventricular fibrillation (VT/VF) Patients receiving therapeutic hypothermia (TH) defined as 32 - 34°C maintained for 24h following ROSC Exclusion: Patients with ECG criteria for STEMI Definitions: Early Cardiac Catheterization = Catheterization performed either immediately upon hospital admission or during hypothermia treatment (i.e. 1st 24hours) Late Cardiac Catheterization = Catheterization performed at any other time during hospitalization (i.e. 24h after admission) Significant Coronary Lesions = Coronary Lesions with a ≥50% angiographic luminal stenosis Acute Coronary Occlusion = Thrombolysis in Myocardial Infarction (TIMI) grade 0 or 1 flow, if there was angiographic evidence of thrombus at the site of occlusion, or by the ability to pass a guidewire easily through the occluded segment Median Follow Up Intervals = 5 months for patients treated with early CC and 6 months for all other patients Outcomes: Primary: Survival to Hospital Discharge Secondary: Neurologic function of survivors at hospital discharge, left ventricular function at hospital discharge, survival to follow-up, and neurologic function at follow up (Neurologic function was determined using Cerebral Performa...