Objectives & Background The rate of survival to discharge from an out-of-hospital cardiac arrest (OOHCA) is ∼10%. In patients with OOHCA improved survival rates have been reported in patients who have a ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI). The evidence for patients without STEMI is unclear.
The aim of this paper was to review our current management of patients following an OOHCA with ventricular fibrillation (VF); to determine how sensitive and specific our current practice is at ruling in and out stentable lesions, and to determine whether staff have a consistent approach.
Methods Patients were identified retrospectively, over a 6-month period, through the ICNARC database using diagnostic codes. All notes were reviewed to determine if the patient had an angiogram performed, whether this was an emergency procedure and if a PCI was performed. Sensitivity and specificity was determined for our current practice at ruling in and out stentable lesions. Survival was determined at six months.
Cardiologists and Emergency Physicians were shown the ECG of each patient, blinded to the patient identification. They were given a short clinical history and asked to decide if the patient should have undergone an immediate angiography.
Results 27 patients were included. 12 patients had an immediate angiogram of whom eight had a PCI. A further four patients had a delayed angiogram, of whom three had PCI performed. The sensitivity and specificity of our current practice for ruling in and out stentable lesions was 73% and 75% respectively. Emergency physicians and Cardiologists were 91% and 78% sensitive respectively, and 54% and 78% specific. There was a wide variation in practice within each group of specialists.
Conclusion Less than 50% of patients who had an OOHCA from VF underwent immediate coronary angiography. In those patients that did not undergo immediate coronary angiography, a delayed angiography was performed in 27%, of whom 75% had a PCI. Current practice resulted in a sensitivity and specificity that was too low to rule in or out stentable lesions.
Emergency Physicians would arrange for more patients to have immediate angiography following cardiac arrest compared with Cardiologists. This would result in more patients with stentable lesions having PCI performed immediately, but would result in more cases of immediate angiography being performed in patients who do not have stentable lesions.
- emergency departments
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