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.

When to Take Cardiac Arrest Patient...
When to Take Cardiac Arrest Patients to the Cath Lab: One-Minute Journal Club

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

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