The role of the Cardiac Cath Lab following Cardiac Arrest and Post-Cardiac Arrest Revascularization is discussed. Coronary artery disease is the most common cause of sudden cardiac death. Early CAG can identify potentially treatable causes of arrest like STEMI. Studies show improved survival rates, up to 56%, with standardized post-arrest protocols including immediate CAG and PCI when indicated. Early revascularization may improve neurological outcomes by reducing reperfusion injury following resuscitation.

1. 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 บุค คลากร
ทางการแพทย์
No flow -– Slow flow --- ROSC -- Consciousness
No flow Reperfusion
Reperfusion
injury injury

3. บุค คล
ประชาชน
ากร .
ทางการ

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

7. WHY: not perform early CAG

8. Neurological Prognosis

11. 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

12. 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

13. Spaulding etal. [8]
in N Engl J Med 1997, 336:1629-1633.
Immediate CAG in survival of OHCA

17. 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%

18. Dumas et al. Circulation Intervention.
June 2010
435OHCA immediate CAG
EKG 31% STEMI 69% NSTEMI
Identified lesion 96% 58%
PCI 74% 26%

19. Dumas et al. Circulation Intervention. June 2010

20. Immediate PCI for survival of OHCA
Dumas et al. Circulation Intervention. June 2010