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Optimal Timing for Revascularization after Cardiac Arrest

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Presented by Dr. Sopon Krissanarungson on 10 August 2012 in Thai Heart Mid-Year Meeting

Published in: Health & Medicine, Technology
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Optimal Timing for Revascularization after Cardiac Arrest

  1. 1. The role of Cardiac Cath Lab Following Cardiac Arrest and Post-Cardiac Arrest Revascularization10 August 2012 Sopon KrisanarungsonM.D. Midyear meetinh HAT Cardiologist Police General Hospital www.facebook.com/thaiCPR
  2. 2. 1 2 3 4 5 1 2 3 4 4 5 5 ประชาชน บุค คลากร ทางการแพทย์No flow -– Slow flow --- ROSC -- Consciousness No flow Reperfusion Reperfusioninjury injury
  3. 3. บุค คลประชาชน ากร . ทางการ
  4. 4. The role of Cardiac Cath Lab Following Cardiac Arrest• 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%
  5. 5. Anyfantakis et al. Am Heart J 200972 Pts with OHCA Undergoing Routine CAG
  6. 6. WHY: not perform early CAG
  7. 7. Neurological Prognosis
  8. 8. Level of Evidence for Primary PCIFollowing Resuscitated Cardiac Arrest• All RCT for primary PCI: excluded cardiac arrest patient• Majority of data: observation• Studies of cardiac arrest: small, patient selection
  9. 9. 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
  10. 10. Spaulding etal. [8] in N Engl J Med 1997, 336:1629-1633.Immediate CAG in survival of OHCA
  11. 11. 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%
  12. 12. Dumas et al. Circulation Intervention. June 2010435OHCA immediate CAGEKG 31% STEMI 69% NSTEMIIdentified lesion 96% 58%PCI 74% 26%
  13. 13. Dumas et al. Circulation Intervention. June 2010
  14. 14. Immediate PCI for survival of OHCA Dumas et al. Circulation Intervention. June 2010

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