Notfall + Rettungsmedizin

, Volume 15, Issue 6, pp 500–504 | Cite as

Acute angiography for all resuscitated patients upon hospital admission

Leitthema
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Abstract

Any patient resuscitated from out-of-hospital cardiac arrest thought to have a cardiac etiology should have emergency coronary angiography upon arrival at the hospital. No current algorithm correctly identifies who has an acutely occluded coronary artery as their cardiac arrest trigger and who does not. However, 75% of those with ST elevation and 33% of those without ST elevation on their postresuscitation electrocardiogram have an acutely occluded coronary artery. To choose not to perform acute coronary angiography and reperfusion in all postresuscitation patients will leave at least one in three patients with significant myocardial loss, thus, resulting in chronic left ventricular dysfunction and heart failure.

Keywords

Cardiac arrest Coronary angiography Postresuscitation treatments Coronary reperfusion Cardiopulmonary resuscitation 

Akute Angiographie für alle Reanimationspatienten bei Aufnahme in die Klinik

Zusammenfassung

Jeder Patient mit Zustand nach erfolgreicher kardiopulmonaler Reanimation außerhalb des Krankenhauses sollte bei vermuteter kardialer Genese des Kreislaufstillstandes einer notfallmäßigen Koronarangiographie zugeführt werden. Mit keinem der bestehenden Algorithmen lässt sich sicher identifizieren, bei welchem Patienten der Herzstillstand durch einen Koronararterienverschluss ausgelöst wurde bzw. bei welchem Patienten durch andere Ursachen. Eine akut verschlossene Koronararterie haben 75% der Patienten mit und 33% der Patienten ohne ST-Streckenhebung im EKG nach Reanimation. Ohne eine akut durchgeführte Angiographie mit Rekanalisation für alle Patienten nach Reanimation wird es bei mindestens einem von drei Patienten zu einem signifikanten Myokardverlust mit konsekutiver linksventrikulärer Dysfunktion und Herzinsuffizienz kommen.

Schlüsselwörter

Herzstillstand Koronarangiographie Behandlung nach Reanimation Koronare Reperfusion Kardiopulmonale Reanimation 

Notes

Conflict of interest

The corresponding author states the following: Karl B. Kern, MD, has no conflict of interest regarding this manuscript and work, but is a consultant for Zoll Medical receiving an hourly consultant fee for such consultancy.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Section of Cardiology, Sarver Heart CenterUniversity of ArizonaTucsonUSA

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