Importance of Invasive Interventional Strategies in Resuscitated Patients Following Sudden Cardiac Arrest

Karl B Kern

Disclosures

Interv Cardiol. 2011;3(6):649-661. 

In This Article

Abstract and Introduction

Abstract

Post-resuscitation care has become a major part of the chain of survival for victims of cardiac arrest. Once spontaneous circulation is restored, it is important to consider early coronary angiography and concurrent use of mild therapeutic hypothermia. In those resuscitated from an arrest considered to be cardiac in origin, coronary angiography should be performed inmmediately to identify any culprit coronary occlusion or unstable lesions. If a culprit lesion is found, immediate percutaneous coronary intervention should be performed. Any out-of-hospital cardiac arrest victim successfully resuscitated, but who remain comatose after return of spontaneous circulation, should be cooled to 32–24°C for 24 h. Induction of mild hypothermia can be accomplished without delaying coronary intervention. When these two post-resuscitation therapies are provided concurrently long-term survival is 50–60%, with favorable neurological function achieved in 80–90% of such survivors.

Introduction

Sudden cardiac arrest continues to be a major public health problem in the industrialized world. An estimated 300,000 such deaths occur in the USA each year alone. Remarkable improvements in survival have finally begun to occur in the last decade after nearly 40 years of consistently poor rates of only 2–5% survival.[1] New emphasis on uninterrupted chest compressions, timely defibrillation, immediate chest compressions post-defibrillation, delayed endotracheal intubation and avoiding hyperventilation has improved resuscitation from out-of-hospital cardiac arrest in a number of communities.[2–10] Although all of these reports were historically controlled rather than randomized, the consistent improvement in outcome is striking (Table 1).

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