Management of Out-of-Hospital Cardiac Arrest Patients

Introduction to Guideline Changes

• The American Heart Association and American College of Cardiology recommend that immediate angiography is not beneficial (Class 3: No Benefit) for comatose out-of-hospital cardiac arrest (OHCA) patients who are electrically and hemodynamically stable without ST-elevation myocardial infarction (STEMI) 1

Diagnostic Approach

• The American College of Cardiology suggests obtaining a 12-lead ECG immediately post-return of spontaneous circulation (ROSC) to assess for STEMI 1
• If STEMI is present, the American College of Cardiology recommends activating the catheterization lab and transferring the patient to a percutaneous coronary intervention (PCI)-capable center (Class I) 1, 5

Management of STEMI Patients

• The American College of Cardiology recommends proceeding to PCI for noncomatose or comatose STEMI patients with favorable prognostic features (Class I, LOE B-NR) 1
• For comatose STEMI patients with unfavorable prognostic features, the American College of Cardiology suggests that PCI may be reasonable after individualized assessment (Class 2b, LOE C-LD) 1

Management of Non-STEMI Patients

• The American College of Cardiology recommends deferring catheterization for risk stratification in hemodynamically and electrically stable non-STEMI patients (Class 3: No Benefit, LOE A) 1
• The European guidelines suggest considering catheterization as soon as possible (less than 2 hours) in non-STEMI patients without an obvious non-coronary cause, especially if hemodynamically unstable 3, 4

Prognostic Features for Risk Stratification

• The American College of Cardiology identifies unfavorable prognostic indicators for comatose STEMI patients, including unwitnessed arrest, no bystander CPR, nonshockable rhythm, CPR duration >30 minutes, time to ROSC >30 minutes, arterial pH <7.2, lactate >7 mmol/L, age >85 years, and end-stage renal disease on dialysis 1