Coronary angiography following out-of-hospital cardiac arrest (OHCA): a review of outcomes and clinical considerations

ABSTRACT

Introduction

In patients suffering a sudden out-of-hospital cardiac arrest (OHCA), the prevalence of a coronary artery lesion as the underlying cause is relatively high, but many other causes have been described. For this reason, identifying patients who would benefit from an emergency coronary angiography is important.

Areas covered

In the present manuscript, we reviewed the literature covering some relevant studies regarding the role of coronary angiography in patients with OHCA, including our local algorithm for the management of patients with OHCA. We particularly focused on the selection of patients who would benefit from an emergency coronary angiography, the time period until the performance of the angiography, the role of extracorporeal cardiopulmonary resuscitation (ECPR), the identification of a coronary artery lesion as the underlying cause of cardiac arrest and clinical outcomes.

Expert opinion

In summary, a local standard algorithm for the management of patients with OHCA appears favorable. An emergency coronary angiography should be advised in patients with a presumed cardiac cause and without obvious non-cardiac cause. A shockable initial rhythm, ST elevation in the post-resuscitation ECG, a previously known coronary artery disease, and ECPR are important predictors of cardiac cause of OHCA.

KEYWORDS:

• Out-of-hospital cardiac arrest (OHCA)
• coronary angiography

Article highlights

1. The most frequent underlying cause of OHCA is coronary artery disease, with 12-40% of all OHCA cases in our experience.

2. In patients with ST-segment elevation in the post-resuscitation ECG, an initial shockable rhythm and a previously known coronary artery disease, a cardiac cause of OHCA is probable.

3. In patients with a suspected cardiac cause of OHCA, an immediate coronary angiography should be performed, because this strategy improves outcome.

4. In patients with presumed non-cardiac cause of OHCA (without ST-segment elevation in the post-resuscitation ECG, without shockable initial rhythm and patients with relevant trauma or injuries due to resuscitation), immediate resuscitation room management with consecutive whole-body computer tomography is recommended, and coronary angiography should be posponed.

Reviewer disclosures

One peer reviewer reports receiving research funds from ZOLL Circulation which manufacturers and markets intravascular temp management. The same reviewer is also a consultant to Abiomed which manufactures and markets Impella. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.