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Presented by Dr. Sopon Krissanarungson on 10 August 2012 in Thai Heart Mid-Year Meeting
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The role of Cardiac Cath Lab Following Cardiac Arrest
and Post-Cardiac Arrest Revascularization
10 August 2012 Sopon Krisanarungson M.D. Midyear meetinh HAT Cardiologist
Police General Hospital
www.facebook.com/thaiCPR
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ประชาชน บุคคลากรทางการแพทย์�
No flow -– Slow flow --- ROSC -- Consciousness
No flow Reperfusion injury
Reperfusion injury
ประชาชน . บุคคลากร ทางการแพทย์�
• CAD: most common cause of sudden cardiac death • Cardiac cause : responsible for most OHCA cases• Coronary artery disease 65%• Structural hear disease 10%
• Other: primary arrhythmias, non-cardiac cause, metabolic abnormalities, etc 30%
The role of Cardiac Cath Lab Following Cardiac Arrest
Anyfantakis et al. Am Heart J 2009 72 Pts with OHCA Undergoing Routine CAG
WHY: not perform early CAG
Neurological Prognosis
Level of Evidence for Primary PCI Following Resuscitated Cardiac Arrest
• All RCT for primary PCI: excluded cardiac arrest patient
• Majority of data: observation• Studies of cardiac arrest: small, patient
selection
Spaulding et al. [8]in N Engl J Med 1997, 336:1629-1633.
Immediate CAG in survival of OHCA
• Routine CAG after + PCI when necessary• A 38% survival rate • MTH not used as a standard of care
Spaulding etal. [8]in N Engl J Med 1997, 336:1629-1633.
Immediate CAG in survival of OHCA
Sunde k et al. [7]Resuscitation 2007, 73:29-39
• Implementation of a standardized treatment protocol for post resuscitation care after OHCA
• Increase survival from 26% to 56%
Dumas et al. Circulation Intervention. June 2010
435OHCA immediate CAG
EKG 31% STEMI 69% NSTEMIIdentified lesion 96% 58%PCI 74% 26%
Dumas et al. Circulation Intervention. June 2010
Immediate PCI for survival of OHCA
Dumas et al. Circulation Intervention. June 2010