OUT OF HOSPITAL CARDIAC ARREST AND PRIMARY PCI · OUT OF HOSPITAL CARDIAC ARREST AND PRIMARY PCI...
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OUT OF HOSPITAL CARDIAC ARREST AND PRIMARY PCI THESSALONIKI 30/10/2015 Georgios Sideris LARIBOISIERE HOSPITAL PARIS
Transcript of OUT OF HOSPITAL CARDIAC ARREST AND PRIMARY PCI · OUT OF HOSPITAL CARDIAC ARREST AND PRIMARY PCI...
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
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STEMI-OHCAPre-hospital management
in Paris
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C CC C
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SAMU: Emergency Medical Service(EMS)C:cathlab
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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
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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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