“All patients with return of spontaneous circulation after out of hospital cardiac arrest should have an urgent cardiac catheterisation, including patients with normal post resuscitation ECGs.”
What are the advantages and disadvantages of this approach?
This question is essentially the same as Question 18 from the first paper of 2018, except that this time the examiners asked for "advantages and disadvantages" instead of "pros and cons". Sensitive readers may find themselves awake at night, wondering what sort of hidden meaning might be lurking in these seemingly random changes. On one hand, this certainly does not look like a deliberate creative decision; on the other hand, surely every inch of this exam paper must be lovingly crafted by experts in medical education? To believe otherwise would be to go mad. Before the reader loses all hope, here are the advantages and disadvantages of urgent post-cardiac-arrest angiography:
Pros Advantages: Cons Disadvantages:
What's happened since the last time this appeared in 2018?
Lemkes, Jorrit S., et al. "Coronary angiography after cardiac arrest: Rationale and design of the COACT trial." American heart journal 180 (2016): 39-45.
Lemkes, Jorrit S., et al. "Coronary angiography after cardiac arrest without ST-segment elevation." New England Journal of Medicine 380.15 (2019): 1397-1407.
Spaulding, Christian M., et al. "Immediate coronary angiography in survivors of out-of-hospital cardiac arrest." New England Journal of Medicine 336.23 (1997): 1629-1633.
Hollenbeck, Ryan D., et al. "Early cardiac catheterization is associated with improved survival in comatose survivors of cardiac arrest without STEMI." Resuscitation 85.1 (2014): 88-95.
Dumas, Florence, et al. "Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac ArrestClinical Perspective: Insights From the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) Registry." Circulation: Cardiovascular Interventions 3.3 (2010): 200-207.
Geri, Guillaume, et al. "Immediate percutaneous coronary intervention is associated with improved short-and long-term survival after out-of-hospital cardiac arrest." Circulation: Cardiovascular Interventions 8.10 (2015): e002303.
Callaway, Clifton W., et al. "Part 8: post–cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care." Circulation 132.18 suppl 2 (2015): S465-S482.
Nolan, Jerry P., et al. "European resuscitation council and european society of intensive care medicine guidelines for post-resuscitation care 2015: section 5 of the european resuscitation council guidelines for resuscitation 2015." Resuscitation 95 (2015): 202-222.
Wester, Axel, et al. "Coronary angiographic findings and outcomes in patients with sudden cardiac arrest without ST-elevation myocardial infarction: A SWEDEHEART study." Resuscitation 126 (2018): 172-178.
Jentzer, Jacob C., et al. "Early coronary angiography and percutaneous coronary intervention are associated with improved outcomes after out of hospital cardiac arrest." Resuscitation 123 (2018): 15-21.
Verma, Beni R., et al. "Coronary angiography in patients with out-of-hospital cardiac arrest without ST-segment elevation: a systematic review and meta-analysis." Cardiovascular Interventions 13.19 (2020): 2193-2205.
Song, Hwan, et al. "Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry." Journal of Clinical Medicine 10.3 (2021): 439.
Desch et al., "Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation" N Engl J Med 2021;epublished August 29th