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Interventional management of out-of-hospital cardiac arrest
  1. Nicole Karam1,2,
  2. Christian Spaulding1,2
  1. 1 Paris City University, Paris, France
  2. 2 Cardiology Department, European Hospital Georges-Pompidou, Paris, France
  1. Correspondence to Dr Nicole Karam, Paris Centre of Cardiovascular Research, Paris, Île-de-France, France; nicole_karam{at}

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Learning objectives

  • Understand the risks and benefits of interventional management of out-of-hospital cardiac arrest.

  • Select the optimal indications and timing of urgent coronary angiography.

  • Discuss the indications for percutaneous coronary intervention when coronary artery disease is identified.


Out-of-hospital sudden cardiac arrest (OHCA) is a major issue of public health with more than 350 000 deaths per year in the USA and 275 000 in Europe, accounting for almost half of cardiovascular mortality.1 Survival rate remains low, with survival to hospital discharge rarely exceeding 10%, except in some cities where huge efforts were invested in this field.2 3

The two main components of resuscitation are basic life support, which occurs immediately after cardiac arrest and is started by bystanders, and advanced life support, in which interventional cardiology might play an important role. Indeed, coronary artery disease (CAD) has traditionally been encountered in up to 70% of patients undergoing coronary angiogram (CAG) or autopsy after OHCA.4 5 Accordingly, CAG was introduced in the resuscitated OHCA management arsenal and its yield has been assessed in several studies, with controversial results.

The aim of this manuscript is to summarise the available data regarding the potential benefits of CAG, with a focus on the main parameters allowing the identification of optimal candidates for both CAG and percutaneous coronary intervention (PCI) and of the timing for the procedure.

Limitations of CAG in OHCA survivors

Several questions should be answered to select the optimal candidates and timing for CAG. The first is the potential futility of the procedure, essentially in patients with known comorbidities and in end-of-life situations, where resuscitation per se is not necessary. The other situation where futility should be considered is in patients with long no-flow (absence of cardiopulmonary resuscitation >10 min) and low-flow delays (>20 min of cardiopulmonary resuscitation without return of spontaneous circulation (ROSC)), where poor neurological prognosis might wean any …

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  • Contributors NK drafted the manuscript. CS reviewed the draft. Both agreed on the final submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.