Abstract
Patients resuscitated from out-of-hospital cardiac arrest (OHCA) frequently have underlying
coronary artery disease (CAD), but the relationship between the arrest and myocardial
ischemia or infarction due to CAD can be difficult to discern in clinical practice.
Patients often present with clinical profiles that guideline recommendations for appropriate
implantable cardioverter-defibrillator use do not address. In cases of incomplete
revascularization or mild but sustained impairment of ventricular function, it is
not clear if the cause of the cardiac arrest is completely “reversible.” We describe
distinct phenotypes of patients with OHCA and concomitant CAD and highlight current
knowledge gaps in their management and outcomes.
Résumé
Les patients réanimés après un arrêt cardiaque hors de l’hôpital (ACHH) ont souvent
une coronaropathie sous-jacente, mais le lien entre l’arrêt et l’ischémie ou l’infarctus
du myocarde en raison de la coronaropathie peut être difficile à reconnaître dans
la pratique clinique. Les patients présentent souvent des profils cliniques pour lesquels
les recommandations des lignes directrices sur l’utilisation appropriée des défibrillateurs
cardioverteurs implantables ne sont pas formulées. Dans les cas de revascularisation
incomplète ou de détérioration faible, mais prolongée, de la fonction ventriculaire,
on ignore si la cause de l’arrêt cardiaque est complètement « réversible ». Nous décrivons
les différents phénotypes des patients atteints d’une coronaropathie qui subissent
un ACHH et démontrons les lacunes courantes en matière de connaissances sur leur prise
en charge et leur issue.
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References
- Breakthrough in cardiac arrest: reports from the 4th Paris International Conference.Ann Intensive Care. 2015; 5: 22
- Improving temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest.Circ Cardiovasc Qual Outcomes. 2018; 11e003561
- Does early coronary angiography improve survival after out-of-hospital cardiac arrest? A systematic review with meta-analysis.Can J Cardiol. 2017; 34: 180-194
- Prehospital ventricular defibrillation: prognosis and follow-up course.N Engl J Med. 1974; 291: 317-321
- Life-threatening ventricular arrhythmias due to transient or correctable causes: high risk for death in follow-up.J Am Cardiol. 2001; 38: 1718-1724
Article Info
Publication History
Published online: April 05, 2018
Accepted:
April 2,
2018
Received:
February 16,
2018
Footnotes
See page 1082 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
