ACC Council Addresses Cardiac Arrest in Non-STEMI Patients

A new algorithm may be a way to identify proper treatment for resuscitated comatose patients after cardiac arrest, according to a Council Perspective published June 29 in the Journal of the American College of Cardiology.

The algorithm is one of the recommendations proposed by members of the ACC’s Interventional Member Section in response to the lack of guidelines for performing immediate angiography and percutaneous coronary intervention (PCI) in patients without ST-segment elevation (non-STEMI). The authors explain that “there is concern in the interventional community that this may lead to risk-adverse behavior, resulting in suboptimal care by not providing early cardiac catheterization to appropriate patients.”

In addition to the algorithm to identify appropriate care, the authors also recommended that resuscitated comatose patients after cardiac arrest receive care from a multi-disciplinary team, including an interventional cardiologist, prior to the patient’s transfer to the cardiac catheterization laboratory. Patients with unfavorable resuscitation features – including unwitnessed cardiac arrest, initial rhythm non-ventricular fibrillation, lack of bystander cardiopulmonary resuscitation (CPR), ongoing CPR and an age greater than 85 years – may not benefit from coronary intervention, according to the authors. They add that interventional consultation and individualized care may help to identify procedural risk in patients.

Further, the authors recommend that “PCI outcomes in cardiac arrest patients not be included in public reporting,” as it may force clinicians to decide between what is better for patients and what will benefit quality metrics.

Moving forward, the authors note that more research on early PCI in post-cardiac arrest non-STEMI patients is needed, in order to address patient care and survival outcomes.

Clinical Topics: Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Algorithms, Angiography, Arrhythmias, Cardiac, Cardiac Catheterization, Cardiopulmonary Resuscitation, Coma, Heart Arrest, Heart Conduction System, Patient Care, Percutaneous Coronary Intervention, Referral and Consultation, Ventricular Fibrillation

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