References
Which resuscitated patients benefit from PPCI after out of hospital cardiac arrest?
Abstract
Background:
Survival of prehospital cardiac arrest remains low and variable. Angiography in cardiac arrest survivors shows a high incidence of ischaemic heart disease and myocardial infarction (MI) which are treated at regional centres in the UK.
Methods:
A literature search was performed using the healthcare databases Medline and CINAHL in order the answer the question: “Which resuscitated patients benefit from PPCI after out of hospital cardiac arrest?”. There was a screening process to ensure precise relevance to the research question.
Findings:
163 articles were found using Medline and CINAHL. After screening, 11 articles were reviewed in text. The evidence favours the intervention and demonstrates increased survival rates when PPCI is available for patients with cardiac arrest following an MI. The ECG is useful to predict coronary occlusion, but cannot rule it out. Increased journey time to reach a regional PPCI centre appears unlikely to impact negatively upon prognosis.
Conclusions:
There are currently no randomised controlled trials answering this question and the evidence that is available is frequently influenced by selection bias. There is a need to identify patients who will not benefit from the intervention so that a clinical decision rule can be developed to guide practice.
In the UK approximately 60,000 people suffer a prehospital cardiac arrest each year, and in approximately 50% of cases resuscitation is commenced by the ambulance staff (Berdowski et al, 2010). Survival statistics for patients that receive resuscitation attempts remain critically low, ranging from 2 to 12%; this also reflects upon the variable success of resuscitation attempts across the many regions (Perkins and Cooke, 2012). The incidence of coronary artery disease is high in out of hospital cardiac arrest patients and incidences still remain high when the clinician's selection bias for primary percutaneous coronary intervention (PPCI) treatment is removed. In a case review of 72 consecutive patients who survived to hospital admission, coronary angiography findings showed that 63.9% of patients had coronary artery disease and 37.5% had findings consistent with an acute myocardial infarction (MI) (Anyfantakis et al, 2009). The variable survival rates shown by Perkins and Cooke (2012) cannot be explained solely by patient characteristics, implying that differences in hospital based care are at least partly responsible for this (Rea et al, 2010). The procedure currently used to treat myocardial infarction in the UK is Primary Percutaneous Coronary Intervention (PPCI), also known as angioplasty, and this service is accessed by UK ambulance staff via regional specialised centres located within 28 cardiac networks (McLenachan et al, 2012).
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