Optimal Timing for Revascularization after Cardiac Arrest

The role of Cardiac Cath Lab Following Cardiac Arrest

and Post-Cardiac Arrest Revascularization

10 August 2012 Sopon Krisanarungson M.D. Midyear meetinh HAT Cardiologist

Police General Hospital

www.facebook.com/thaiCPR

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ประชาชน บุคคลากรทางการแพทย์�

No flow -– Slow flow --- ROSC -- Consciousness

No flow Reperfusion injury

Reperfusion injury

ประชาชน . บุคคลากร ทางการแพทย์�

• CAD: most common cause of sudden cardiac death • Cardiac cause : responsible for most OHCA cases• Coronary artery disease 65%• Structural hear disease 10%

• Other: primary arrhythmias, non-cardiac cause, metabolic abnormalities, etc 30%

The role of Cardiac Cath Lab Following Cardiac Arrest

Anyfantakis et al. Am Heart J 2009 72 Pts with OHCA Undergoing Routine CAG

WHY: not perform early CAG

Neurological Prognosis

Level of Evidence for Primary PCI Following Resuscitated Cardiac Arrest

• All RCT for primary PCI: excluded cardiac arrest patient

• Majority of data: observation• Studies of cardiac arrest: small, patient

selection

Spaulding et al. [8]in N Engl J Med 1997, 336:1629-1633.

Immediate CAG in survival of OHCA

• Routine CAG after + PCI when necessary• A 38% survival rate • MTH not used as a standard of care

Spaulding etal. [8]in N Engl J Med 1997, 336:1629-1633.

Immediate CAG in survival of OHCA

Sunde k et al. [7]Resuscitation 2007, 73:29-39

• Implementation of a standardized treatment protocol for post resuscitation care after OHCA

• Increase survival from 26% to 56%

Dumas et al. Circulation Intervention. June 2010

435OHCA immediate CAG

EKG 31% STEMI 69% NSTEMIIdentified lesion 96% 58%PCI 74% 26%

Dumas et al. Circulation Intervention. June 2010

Immediate PCI for survival of OHCA

Dumas et al. Circulation Intervention. June 2010