The interventional management of out-of-hospital cardiac arrest

Summary

Out-of-hospital cardiac arrest (OHCA) remains the leading cause of death in developed countries and the number of hospital admissions increases every year. If changes indicative of an ST-segment elevation myocardial infarction (STEMI) are present on the post-resuscitation electrocardiogram (ECG), acute culprit lesions may be found in up to 90% of cases. The absence of STEMI does not exclude acute lesions which may still be present in 25- 58% of cases. Interventional cardiologists are therefore increasingly alerted for coronary angiography (CAG) and percutaneous coronary intervention (PCI), and are becoming an important members of the resuscitation team. Selection for immediate CAG/PCI should be individualized to obtain maximal benefit and avoid futility. Index PCI should focus on the culprit lesion. Acetylsalicylic acid, unfractionated heparin and novel P2Y12 inhibitors should be preferred over clopidogrel. In bailout situations, an intravenous P2Y12 inhibitor cangrelor with rapid “onset-offset” in platelet inhibition, might be preferred over GP llb/llla inhibitors because of a high rate of bleeding complications in these patients. Indications for hemodynamic support devices during the postresuscitation phase as well as for veno-arterial extracorporeal membrane oxygenation (VA ECMO) in refractory cardiac arrest (E-CPR) should be individualized.

Introduction

Sudden out-of-hospital cardiac arrest (OHCA) remains the leading cause...