Invasive Strategy Guidelines for OHCA Patients

Primary Recommendations

The American Heart Association recommends emergency coronary angiography for OHCA patients with ST-elevation on ECG, as more than 80% of these patients have an acute coronary lesion requiring intervention 1, 2, 3, 4, 5
For non-ST-elevation OHCA patients, immediate catheterization is recommended if they are hemodynamically unstable, electrically unstable, or have evidence of ongoing ischemia, with a consideration for delayed/selective catheterization in stable patients 1, 2, 3, 4

The American College of Cardiology suggests assessing ECG immediately after ROSC to identify ST-elevation, and proceeding to emergency catheterization laboratory activation if present (Class I) 1, 2
Focused assessment, including history, examination, chest X-ray, and consider CT scan, should be performed to identify obvious non-cardiac causes 3, 4

The European Society of Cardiology recommends considering immediate catheterization within 2 hours in non-ST-elevation patients without obvious non-cardiac cause, particularly if hemodynamically unstable 3, 4
Targeted temperature management should be combined with catheterization for optimal outcomes 3, 4, 5

Comatose state alone should not preclude catheterization if ST-elevation is present, and immediate catheterization should be reserved for hemodynamic or electrical instability in non-ST-elevation comatose patients 1, 2, 7
Transfer to PCI-capable centers is justified for ST-elevation OHCA, and mechanical circulatory support devices can be used in refractory cardiogenic shock 1, 3, 4