Early Systematic Coronary Angiography in All Out-Of-Hospital Cardiac Arrests Seems Reasonable
The most recent guidelines of the European Resuscitation Council and the American Heart Association recommend that resuscitated patients of presumed cardiac cause should undergo immediate coronary angiography with subsequent PCI if indicated, regardless of clinical symptoms and/or ECG criteria. However, this approach is discussed controversially as we don't know if there is any benefit on performing an angiography in every out-of-hospital cardiac arrest (OHCA). Additionally such an approach might be associated with quite some logistical and organisational problems for certain institutions.
In this noteworthy and open access review article Geri et al. discuss current literature and state that there are no randomised studies looking at acute coronary angiography in OHCA patients. A large number of observational studies though supports feasibility and a possible survival benefit of an early invasive approach.
They conclude that even in the absence of large randomised studies, it is probable that an early coronary revascularization is associated with a significant clinical benefit in OHCA survivors.
Providing the patient had no other obvious reason for OHCA (sepsis, haemorrhage, metabolic disorder etc.) current literature strongly encourages performing a systematic coronary angiography in all OHCA patients.
Geri G et al., Current Opinion in Critical Care, June 2014, Vol 20, Issue 3 (Open Access)
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