A 20 y.o. woman presents with a cardiac arrest; ROSC is obtained.

Would you activate the cath lab based on her EKG?

The cath lab was called for this patient.

The second EKG however convinced the cardiologist not to cath the patient.

Ischemic changes have resolved

. The likelihood of an acute coronary occlusion in a 20 y.o. with presumably a hypoxic arrest from a fentanyl OD is small.  These EKGs more likely represent demand ischemia from prolonged hypoxia.

Cardiac arrest accounts for 500,000 deaths in the US and Europe annually, with out-of-hospital arrest survival at <15%. It is being debated whether cath should be done urgently on patients with return of spontaneous circulation whether or not they have ST elevation. Current studies often demonstrate selection bias in studies of cardiac cath post arrest with only those with a perceived favorable neurologic outcome being taken for cath. Unwitnessed arrests, CPR for 30 minutes or longer prior to ROSC and lack of spontaneous respirations are predictors of poor outcome.

The current points to remember are:

1.   Patients presenting with out of hospital cardiac arrest in a shockable rhythm have a high probability of coronary disease

2.   Observational case series suggest that among patients resuscitated with persistent ST elevation, the prevalence of CAD has been shown to be 70-85%.  In patients resuscitated with no persistent ST elevation, the incidence of coronary disease is 25%.

3.   The ongoing ARREST trial will address cost per life saved and should provide further guidance.

Our patient was declared brain dead and the family donated her organs.

Yannopoulos D, Aufderheide T, et al. The evolving role of the cardiac catheterization laboratory in the management of patients with out-of-hospital cardiac arrest: A scientific statement from the American Heart Association. 2019 Circulation Feb 14.

Reddy S, Lee K.  Role of cardiac catheterization lab post resuscitation in patients with ST elevation MI. Curr Cardiol. Rev. 2018;14(2)85-91.

Chan P, McNally B, Tang F, Kellermann A. Group CS. Recent trands in survival from out-of –hospital cardiac arrest in the United States. Circulation 2014;130(21):1876-82.