TY - JOUR
T1 - Coronary Revascularization and Out-of-hospital Cardiac Arrest
T2 - Past, Present and Future
AU - Wa, Matthew E.Li Kam
AU - De Silva, Kalpa
AU - Pareek, Nilesh
AU - Perera, Divaka
N1 - Funding Information:
Disclosures: Matthew E Li Kam Wa, Kalpa De Silva, Nilesh Pareek and Divaka Perera are supported by grants from the British Heart Foundation (including CS/16/3/32615 for the ARREST trial and the Centre of Research Excellence Award, RE/18/2/34213), and the UK National Institute for Health Research through the Biomedical Research Centre award to King’s College London and Guy’s and St Thomas’ Hospital.
Publisher Copyright:
© 2021, Touch Medical Media. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Cardiologists and the cardiac catheter laboratory have key roles to play in the management of patients after out-of-hospital cardiac arrest (OHCA). Although immediate catheter laboratory activation is the standard of care in cardiogenic shock and ST elevation myocardial infarction, the majority of patients will present without these features and with an uncertain diagnosis. Even in the latter, early assessment and invasive management may be beneficial, but this is counterbalanced by significant resource utilization, potential to cause harm and the possibility that any diagnostic or therapeutic gains are offset by a poor neurological outcome. Past consensus on the management of the OHCA patient without ST elevation or cardiogenic shock is being challenged by emerging results from new trials in this field. Further randomized trials are ongoing, and are expected to deliver robust data from over 4,000 patients, allowing us to further refine the optimal management strategy in this challenging cohort. This article describes the benefits and pitfalls of a strategy of immediate coronary angiography in these patients, examines the recently published COACT and TOMAHAWK trials in detail, and describes a framework with which to approach the patient after resuscitated OHCA, based on the available evidence to date.
AB - Cardiologists and the cardiac catheter laboratory have key roles to play in the management of patients after out-of-hospital cardiac arrest (OHCA). Although immediate catheter laboratory activation is the standard of care in cardiogenic shock and ST elevation myocardial infarction, the majority of patients will present without these features and with an uncertain diagnosis. Even in the latter, early assessment and invasive management may be beneficial, but this is counterbalanced by significant resource utilization, potential to cause harm and the possibility that any diagnostic or therapeutic gains are offset by a poor neurological outcome. Past consensus on the management of the OHCA patient without ST elevation or cardiogenic shock is being challenged by emerging results from new trials in this field. Further randomized trials are ongoing, and are expected to deliver robust data from over 4,000 patients, allowing us to further refine the optimal management strategy in this challenging cohort. This article describes the benefits and pitfalls of a strategy of immediate coronary angiography in these patients, examines the recently published COACT and TOMAHAWK trials in detail, and describes a framework with which to approach the patient after resuscitated OHCA, based on the available evidence to date.
KW - Cardiac catheterization
KW - Coronary angiography
KW - Non-ST elevation myocardial infarction
KW - Out-of-hospital cardiac arrest
KW - Percutaneous coronary intervention
KW - Real-world clinical trials
UR - http://www.scopus.com/inward/record.url?scp=85123938888&partnerID=8YFLogxK
U2 - 10.17925/HI.2021.15.2.94
DO - 10.17925/HI.2021.15.2.94
M3 - Article
AN - SCOPUS:85123938888
SN - 1826-1868
VL - 15
SP - 94
EP - 102
JO - Heart International
JF - Heart International
IS - 2
ER -
