PCI after Cardiac Arrest

Practice Change:  After an ECG, ABG, and beside electrolytes all comatose post-arrest patients with ROSC should be discussed with the cardiologist for emergency PCI – up to 25% may benefit. 



Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient

JACC – July 2015

The JACC published new guidelines for cardiac arrest patients.  Essentially it suggests you should consider treating all comatose arrest patients (both with and without STEMI on ECG) with PCI.  The data they present suggest that about 25% of patients with ROSC, but without STEMI on ECG, will have an occluded culprit vessel that can be opened with PCI.

Journal of the American College of Cardiology, 66 (2015) 62-73. doi:10.1016/j.jacc.2015.05.009

Journal of the American College of Cardiology, 66 (2015) 62-73. doi:10.1016/j.jacc.2015.05.009

While they do try to differentiate between NSTEMI and STEMI patients, you’ll notice that other than one side being red and the other blue, the algorithms are identical.

ED physicians will have to evaluate for poor prognostic signs in the ED, but as the cut off is “multiple unfavorable resuscitation features,” it sounds like this decision will be in the cardiologist’s court.

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