Optimal treatment of patients surviving out-of-hospital cardiac arrest.

Interest in post-resuscitation care has risen with the development of treatment modalities that can affect long-term survival rates even when begun after the systematic ischemia/reperfusion insult associated with cardiac arrest. Mild therapeutic hypothermia has become the foundation for improvement of neurologically favorable survival after cardiac arrest. Reperfusion therapy, specifically early percutaneous coronary intervention, is becoming an important adjunct to therapeutic hypothermia. Identifying which post-cardiac arrest patient had an occluded or unstable coronary vessel is difficult because such events are not reliably predicted by precedent symptoms or standard electrocardiographic analysis. Increasing clinical experience suggests that resuscitated cardiac arrest victims without an obvious noncardiac etiology should undergo emergency coronary angiography and, where indicated, percutaneous coronary intervention. If comatose, they should receive concurrent therapeutic hypothermia. Such an approach can double long-term survival rates among those successfully resuscitated after out-of-hospital cardiac arrest.