Out of Hospital cardiac arrest - who should we directly take to Cath lab?


Take Home Messages
  • Immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST segment elevation.
  • Multiple randomised controlled trials have demonstrated no benefit of immediate CAG for haemodynamically stable patients following OHCA without ST elevation and this is reflected in the European Society of Cardiology Guidelines 2023.
  • Combined classification of patients with OHCA with 12-lead ECG, a MIRACLE2 score of 0 to 3, and a SCAI grade of B to E identifies a potential cohort at low-risk for neurologic injury that benefits most from immediate coronary angiogram.
  • The value of collateral history and multidisciplinary team (MDT) discussion is of utmost importance in management of Out of Hospital Cardiac arrest (OHCA).

Cardiac arrest is an important cause of death in England. With less than one in ten patients surviving, there is scope to improve outcomes (1). The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest(OHCA) is uncertain for patients without ST-segment elevation. Where Return of SpontaneousCirculation (ROSC) has been achieved and ST elevation persists, clinical research has shown that emergency coronary angiography guided therapy, which may include PPCI, improves prognosis (2-3). However, it is also recognised that for some patients with ROSC and without ST elevation, emergency coronary angiography may not be of benefit and is therefore not always indicated (4-5). Careful and considered assessment of these patients is essential before deciding on an appropriate management plan.