When to Take Cardiac Arrest Patients to the Cath Lab

A patient has a cardiac arrest and ROSC was achieved.
They present to the ER or ICU.
Suspicion is high that this was a cardiac insult.
The EKG, though, does not show a STEMI.
Troponins are elevated. The patient has a cardiac history.
Have you ever wondered why intensivists never ask cardiology to take the patient to the cath lab to fix the likely insult?
Should we push to take this cardiac arrest patient to the cath lab immediately if it is not a STEMI or wait a couple days?
This is not medical advice. Hat tip to the authors.
In my practice, as long as they’re stable, I hold off on asking my interventional cardiology colleagues to take the patient to the cath lab.
A new randomized clinical trial was published in JAMA looking at this question.
279 patients were enrolled in this trial.
The primary endpoint was 180 day survival.
There was no difference but the study was underpowered.
Survival was 34% in the early cath vs. 31% in the late cath group.
Take a second to let this register.
Only one third of out of hospital cardiac arrest patients survive at 180 days.
There was no difference in the secondary outcomes either.
This supports not taking cardiac arrest patients who achieved ROSC immediately to the cath lab.
If your patient goes into cardiogenic shock, they may need mechanical circulatory support.

Citation for the article about taking cardiac arrest patients to the cath lab.

Hauw-Berlemont C, Lamhaut L, Diehl JL, Andreotti C, Varenne O, Leroux P, Lascarrou JB, Guerin P, Loeb T, Roupie E, Daubin C, Beygui F, Boissier F, Marjanovic N, Christiaens L, Vilfaillot A, Glippa S, Prat JD, Chatellier G, Cariou A, Spaulding C; EMERGE Investigators. Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial. JAMA Cardiol. 2022 Jul 1;7(7):700-707. doi: 10.1001/jamacardio.2022.1416. PMID: 35675081; PMCID: PMC9178496.
Link to NOT FREE Article

How to Support My Work

My efforts are at no cost to you and I would like to keep it that way. You have to look at ads on this website, listen to them on my podcast and YouTube content. Thanks for bearing with me. You could also support my work by clicking on my Amazon Affiliate links prior to ordering things off of Amazon.

For example, if you want to learn more about Mechanical Ventilation, I recommend starting off with The Ventilator Book by Will Owens. If you click on that link, a window for Amazon will open up and I will earn between a 1-3% commission at no expense to you. The fun thing is that if you order anything else on Amazon, I will earn that amount off of your shopping cart even if you do not purchase the book. Pretty cool, right? In 2021, Amazon Affiliates helped me pay for the hosting of my website, LLC fees, and Netflix.


Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.