Which resuscitated patients benefit from PPCI after out of hospital cardiac arrest?

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).