OUT OF HOSPITAL CARDIAC ARREST AND PRIMARY PCI

THESSALONIKI 30/10/2015Georgios Sideris

LARIBOISIERE HOSPITALPARIS

OUT OF HOSPITAL CARDIAC ARREST and PPCI………

thelancet Vol 374 October 3, 2009

Coloured scanning electron micrograph of bloodclot in coronary artery

From vulnerable plaque to MI and Cardiac arrest

326 000 Cardiac arrest

100 000 CPR

40 000 Hospital Admission

28 000 Hospital discharge

12 000 CPC 1 or 2

November 2, 2010

OHCA: Survival < 15%

8,4%

30-40%CA : MI etiology

C

STEMI-OHCAPre-hospital management

in Paris

C

C

C C

C

C CC C

C

C

C

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SAMU: Emergency Medical Service(EMS)C:cathlab

C

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STEMIPre-hospital management in Paris

OHCA

From clinical observation to animal model

Immediate coronary angiography insurvivors of out-of-hospital cardiac arrest

Spaulding et al. N Engl J Med. 1997; 336:1629-33

Variables Value

Clinically insignificant CAD – no. (%) 7 (8)

LV end diastolic pressure - mmHg 25.3 9.5

Hospital survival rate: 38% Successful PTCA is protective (OR:5.2, CI 1.1-24.5;p=0.04)

60 (71)Clinically significant CAD – no. (%)

LVEF – % 33.9 10.5

Normal coronary arteries – no. (%) 17 (20)

Proportion of pts with a recent coronary occlusion 40 (48)

Survival rate after sudden cardiac death treated withimmediate angioplasty

38

55

69

48,6

78

0

20

40

60

80

100

Spaulding, NEJM1997

Garot, Circulation2007

Wolfrum, Crit CareMed 2008

Anyfantakis,JACC 2009

Lettieri, Am HeartJ 2009

PCI Following ROSC After Cardiac ArrestDespite the lack of data from RCTs in this situation, the performance of PCI has been associatedwith favorable outcomes in this setting and is supported by the observation that following earlyangiography, half of the studied population is noted to have an acute coronary occlusion.

Part 10: Acute Coronary Syndromes: 2010 American Heart Association Guidelines for CardiopulmonaryResuscitation and Emergency Cardiovascular Care

Circulation November 2, 2010

Treatment RecommendationIn OHCA patients with STEMI or new LBBB on ECG following ROSC, early angiography andPPCI should be considered. It is reasonable to perform early angiography and PPCI inselected patients despite the absence of ST-segment elevation on the ECG or prior clinicalfindings, such as chest pain, if coronary ischemia is considered the likely cause on clinicalgrounds.Out-of-hospital cardiac arrest patient are often initially comatose but this should not be acontraindication to consider immediate angiography and PCI. It may be reasonable to includecardiac catheterization in a standardized post– cardiac-arrest protocol as part of an overallstrategy to improve neurologically intact survival in this patient group.

OHCA

From clinical observation to animal model

Post CA PCI : Sometimes.......

• Mr Ry 49 y.o.• Current smoker• Anterior MI• Refractory VF

Post CA PCI : Sometimes.......

Post CA PCI : Sometimes.......

Post CA PCI : Sometimes.......

Post CA PCI : Sometimes.......

OHCA

• Mr Ro, 53 y.o.• Current smoker• Comorbidities=0• Medication=0

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

OHCA

Day+8…

2 months later…..

2 months later…..

2 months later…..

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