Purpose of Review

The role of emergent cardiac catheterization after resuscitated out-of-hospital cardiac arrest (OHCA) has evolved based on recent randomized evidence. This review aims to discuss the latest evidence and current indications for emergent coronary angiography (CAG) and mechanical circulatory support (MCS) use following OHCA.

Recent Findings

In contrast to previous observational data, recent RCTs evaluating early CAG in resuscitated OHCA patients without ST elevation have uniformly demonstrated a lack of benefit in terms of survival or neurological outcome. There is currently no randomized evidence supporting MCS use specifically in patients with resuscitated OHCA and cardiogenic shock.

Summary

Urgent CAG should be considered in all patients with ST elevation, recurrent electrical or hemodynamic instability, those who are awake following resuscitated OHCA, and those receiving extracorporeal cardiopulmonary resuscitation (ECPR). Recent evidence suggests that CAG may be safely delayed in hemodynamically stable patients without ST-segment elevation following resuscitated OHCA.

中文翻译：

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院外心脏骤停复苏患者的心导管插入术和经皮冠状动脉介入治疗的指征

审查目的

根据最近的随机证据，院外心脏骤停 (OHCA) 复苏后紧急心导管插入术的作用不断发展。本综述旨在讨论 OHCA 后紧急冠状动脉造影 (CAG) 和机械循环支持 (MCS) 使用的最新证据和当前适应症。

最近的发现

与之前的观察数据相反，最近的随机对照试验（RCT）评估了复苏后无 ST 段抬高的 OHCA 患者的早期 CAG，一致证明在生存或神经学结果方面缺乏益处。目前没有随机证据支持 MCS 特别用于复苏的 OHCA 和心源性休克患者。

概括

所有 ST 段抬高、反复电或血流动力学不稳定的患者、OHCA 复苏后清醒的患者以及接受体外心肺复苏 (ECPR) 的患者均应考虑紧急 CAG。最近的证据表明，在 OHCA 复苏后血流动力学稳定且无 ST 段抬高的患者中，可以安全地延迟 CAG。