Florence Dumas1, Wulfran Bougouin2, Guillaume Geri2, Lionel Lamhaut3, Julien Rosencher4, Frédéric Pène5, Jean-Daniel Chiche5, Olivier Varenne4, Pierre Carli6, Xavier Jouven7, Jean-Paul Mira5, Christian Spaulding7, Alain Cariou2. 1. INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP & Paris Descartes University, Paris, France. Electronic address: florence.dumas@cch.aphp.fr. 2. INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France. 3. INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France; Emergency Medical Services, SAMU 75, Necker Hospital, APHP & Paris Descartes University, Paris, France. 4. Department of Cardiology, Cochin Hospital, APHP & Paris Descartes University, Paris, France. 5. Medical Intensive Care Unit, Cochin University Hospital, APHP & Paris Descartes University, Paris, France. 6. Emergency Medical Services, SAMU 75, Necker Hospital, APHP & Paris Descartes University, Paris, France. 7. INSERM U970 (team 4), Parisian Cardiovascular Research Center-PARCC, Paris Descartes University, Paris, France.
Abstract
OBJECTIVES: In a large cohort of out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation (STE), the study assessed the relationship between the use of an early invasive strategy and patient outcome. BACKGROUND: Emergent coronary angiogram (CAG) and reperfusion are currently a standard of care in patients resuscitated from an OHCA with ST-segment elevation (STE). However, using a similar invasive strategy is still debated in patients without STE. METHODS: In the absence of an obvious extracardiac cause, for many years our practice has had to perform an emergent CAG in all OHCA patients (STE and no STE) at admission, followed by percutaneous coronary intervention (PCI) when required. All patients' characteristics are prospectively collected in the PROCAT (Parisian Registry Out-of-Hospital Cardiac Arrest) database. Focusing on non-STE patients and using logistical regression, we investigated the association between early PCI and favorable outcome (cerebral performance category 1 to 2 at discharge) and we searched predictive factors for PCI requirement. RESULTS: During the study period (2004 to 2013), we investigated 958 OHCA patients with an emergent CAG. Among them 695 of 958 (73%), mostly male (76%), and average 60 years of age had no evidence of STE on the post-resuscitation electrocardiography. A PCI was deemed necessary in 199 of 695 (29%). A favorable outcome was observed in 87 of 200 (43%) in patients with PCI compared with 164 of 495 (33%) in patients without PCI (p = 0.02). After adjustment, PCI was associated with a better outcome (adjusted odds ratio: 1.80 [95% confidence interval: 1.09 to 2.97]; p = 0.02). The other predictive factors of favorable outcome were a shorter resuscitation length (<20 min), an initial shockable rhythm, and a lower dose of epinephrine during resuscitation (p < 0.001). An initial shockable rhythm (adjusted odds ratio: 2.83 [95% confidence interval: 1.84 to 4.36]; p < 0.001) was the sole independent indicator for PCI requirement. CONCLUSIONS: A culprit coronary lesion requiring PCI was found in nearly one-third of OHCA patients without STE. In these patients, emergent PCI was associated with a nearly 2-fold increase in the rate of favorable outcome. These findings support the use of an invasive strategy in these patients, particularly in those resuscitated from a shockable rhythm.
OBJECTIVES: In a large cohort of out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation (STE), the study assessed the relationship between the use of an early invasive strategy and patient outcome. BACKGROUND: Emergent coronary angiogram (CAG) and reperfusion are currently a standard of care in patients resuscitated from an OHCA with ST-segment elevation (STE). However, using a similar invasive strategy is still debated in patients without STE. METHODS: In the absence of an obvious extracardiac cause, for many years our practice has had to perform an emergent CAG in all OHCA patients (STE and no STE) at admission, followed by percutaneous coronary intervention (PCI) when required. All patients' characteristics are prospectively collected in the PROCAT (Parisian Registry Out-of-Hospital Cardiac Arrest) database. Focusing on non-STEpatients and using logistical regression, we investigated the association between early PCI and favorable outcome (cerebral performance category 1 to 2 at discharge) and we searched predictive factors for PCI requirement. RESULTS: During the study period (2004 to 2013), we investigated 958 OHCA patients with an emergent CAG. Among them 695 of 958 (73%), mostly male (76%), and average 60 years of age had no evidence of STE on the post-resuscitation electrocardiography. A PCI was deemed necessary in 199 of 695 (29%). A favorable outcome was observed in 87 of 200 (43%) in patients with PCI compared with 164 of 495 (33%) in patients without PCI (p = 0.02). After adjustment, PCI was associated with a better outcome (adjusted odds ratio: 1.80 [95% confidence interval: 1.09 to 2.97]; p = 0.02). The other predictive factors of favorable outcome were a shorter resuscitation length (<20 min), an initial shockable rhythm, and a lower dose of epinephrine during resuscitation (p < 0.001). An initial shockable rhythm (adjusted odds ratio: 2.83 [95% confidence interval: 1.84 to 4.36]; p < 0.001) was the sole independent indicator for PCI requirement. CONCLUSIONS: A culprit coronary lesion requiring PCI was found in nearly one-third of OHCA patients without STE. In these patients, emergent PCI was associated with a nearly 2-fold increase in the rate of favorable outcome. These findings support the use of an invasive strategy in these patients, particularly in those resuscitated from a shockable rhythm.
Authors: Jerry P Nolan; Robert A Berg; Stephen Bernard; Bentley J Bobrow; Clifton W Callaway; Tobias Cronberg; Rudolph W Koster; Peter J Kudenchuk; Graham Nichol; Gavin D Perkins; Tom D Rea; Claudio Sandroni; Jasmeet Soar; Kjetil Sunde; Alain Cariou Journal: Intensive Care Med Date: 2017-03-11 Impact factor: 17.440
Authors: Ulrich Grabmaier; Konstantinos D Rizas; Julius Berghof; York Huflaender; Christopher Wiegers; Reza Wakili; Michael Kaspar; Matthias Angstwurm; Steffen Massberg; Ludwig T Weckbach; Stefan Brunner Journal: Intensive Care Med Date: 2018-03-09 Impact factor: 17.440
Authors: Bryn E Mumma; Machelle D Wilson; María F García-Pintos; Pablo J Erramouspe; Daniel J Tancredi Journal: Resuscitation Date: 2018-12-24 Impact factor: 5.262
Authors: Sunil K Nadar; Mohammed Mujtaba; Hafidh Al-Hadi; Muhammed Sadiq; Adil Al-Riyami; Mehar Ali; Hatim Al-Lawati Journal: Sultan Qaboos Univ Med J Date: 2018-09-09
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440
Authors: Tom P Aufderheide; Rajat Kalra; Marinos Kosmopoulos; Jason A Bartos; Demetris Yannopoulos Journal: Ann N Y Acad Sci Date: 2021-02-20 Impact factor: 5.691