The following are key points to remember from this American Heart Association Scientific Statement about the role of the cardiac catheterization laboratory among patients with out-of-hospital cardiac arrest (OHCA):

1. Patients presenting with OHCA due to shockable rhythms such as ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) have a high probability of having coronary artery disease (CAD).
2. Nonrandomized, observational case series data suggest that among patients resuscitated from VF/pVT OHCA with ST-segment elevation on their post-resuscitation electrocardiogram, the prevalence of CAD has been shown to be 70-85% and access to coronary angiography has a favorable impact on survival to hospital discharge.
3. Consensus on patients who have no evidence of ST-segment elevation after resuscitation suggests that prevalence of CAD is 25-50% and that these patients also benefit from an approach involving urgent cardiac catheterization.
4. For patients who have VF/pVT OHCA refractory to standard treatment, the use of venoarterial extracorporeal membrane oxygenation to support further resuscitation efforts can be considered.
5. An approach utilizing the strategy of venoarterial extracorporeal membrane oxygenation, coronary angiography, and percutaneous coronary intervention has resulted in functionally favorable survival rates, ranging from 9-45% in observational studies.
6. Although aggressive post-resuscitation efforts including coronary angiography, circulatory support can provide substantial benefit, these systems of care utilize costly resources.
7. The ongoing ARREST trial will address survival and cost per life saved and should provide further guidance on optimal care for patients with OHCA and shockable rhythms.

Clinical Topics: Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Arrhythmias, Cardiac, Cardiac Catheterization, Coronary Angiography, Coronary Artery Disease, Electrocardiography, Extracorporeal Membrane Oxygenation, Heart Arrest, Out-of-Hospital Cardiac Arrest, Percutaneous Coronary Intervention, Tachycardia, Ventricular, Ventricular Fibrillation

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