Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI

Ryan D. Hollenbeck, John A. McPherson, Michael R. Mooney, Barbara T. Unger, Nainesh C. Patel, Paul W. McMullan, Chiu Hsieh Hsu, David B. Seder, Karl B. Kern

Research output: Contribution to journalArticle

128 Scopus citations

Abstract

Aim: To determine if early cardiac catheterization (CC) is associated with improved survival in comatose patients who are resuscitated after cardiac arrest when electrocardiographic evidence of ST-elevation myocardial infarction (STEMI) is absent. Methods: We conducted a retrospective observational study of a prospective cohort of 754 consecutive comatose patients treated with therapeutic hypothermia (TH) following cardiac arrest. Results: A total of 269 (35.7%) patients had cardiac arrest due to a ventricular arrhythmia without STEMI and were treated with TH. Of these, 122 (45.4%) received CC while comatose (early CC). Acute coronary occlusion was discovered in 26.6% of patients treated with early CC compared to 29.3% of patients treated with late CC (p= 0.381). Patients treated with early CC were more likely to survive to hospital discharge compared to those not treated with CC (65.6% vs. 48.6%; p= 0.017). In a multivariate regression model that included study site, age, bystander CPR, shock on admission, comorbid medical conditions, witnessed arrest, and time to return of spontaneous circulation, early CC was independently associated with a significant reduction in the risk of death (OR 0.35, 95% CI 0.18-0.70, p= 0.003). Conclusions: In comatose survivors of cardiac arrest without STEMI who are treated with TH, early CC is associated with significantly decreased mortality. The incidence of acute coronary occlusion is high, even when STEMI is not present on the postresuscitation electrocardiogram.

Original languageEnglish (US)
Pages (from-to)88-95
Number of pages8
JournalResuscitation
Volume85
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Cardiac arrest
  • Cardiac catheterization
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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