Cardiac receiving centers: beyond hypothermia

Current Opinion in Critical Care
Karl B Kern

Abstract

The role of cardiac arrest centers, more recently termed Cardiac Receiving Centers, in improving outcomes after successful resuscitation is becoming more and more convincing. But which of all the treatments provided by Cardiac Receiving Centers are most beneficial is less certain. This review examines the role of early coronary angiography and percutaneous coronary intervention in this regard. Cohort studies have consistently found that early coronary angiography is associated with improved long-term outcomes postcardiac arrest. The most common cause for out-of-hospital cardiac arrest is a myocardial ischemic event. Diagnosing and treating the underlying coronary trigger makes good physiological sense. The major issues are 'who' should undergo emergent coronary angiography and 'when' should it be done. Standard criteria such as ST segment elevation and precedent chest pains are not very sensitive in identifying those postcardiac arrest with an occluded or culprit lesion. As many as one in four postresuscitated patients without ST elevation have a significant culprit lesion, including at times an acutely occluded coronary. Cardiac Receiving Centers should have the capacity to perform emergent coronary angiography on every resusc...Continue Reading

References

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