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Looking into the heart of the problem of refractory cardiac arrest

RESUSCITATION (2023)

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Summary: This study compared angiographic features and percutaneous coronary intervention (PCI) between patients undergoing extracorporeal membrane oxygenation (E-CPR) and those with spontaneous circulation after conventional cardiopulmonary resuscitation (C-CPR). The results showed that patients in the E-CPR group had a higher prevalence of multivessel disease, unprotected left main stenosis, and chronic total occlusion, but there were no significant differences in the incidence, features, and distribution of the acute culprit lesion between the two groups.

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Summary: This systematic review and meta-analysis provides an accurate description of angiographic features in resuscitated and refractory out-of-hospital cardiac arrest (OHCA) patients. The study reveals a high prevalence of significant coronary artery disease (CAD) in OHCA patients, especially in those with refractory OHCA. The findings suggest the important clinical implications of coronary angiography in diagnosing and treating CAD in OHCA patients.

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Summary: The study found that in CAD patients after OHCA, bystander CPR, GRACE risk score, revascularization of coronary stenosis, and SYNTAX score were independent predictors of 30-day mortality. When combined, these factors contributed to a gradual increase in 30-day mortality rates.

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Coronary angiography and percutaneous coronary intervention in cardiac arrest patients without return of spontaneous circulation

Daniel Rob et al.

Summary: OHCA patients without ROSC on admission have higher rates of acute coronary occlusions. PCI is feasible with a high success rate in these patients, and meaningful survival is achievable.

RESUSCITATION (2022)

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The effect of the localisation of an underlying ST-elevation myocardial infarction on the VF-waveform: A multi-centre cardiac arrest study

J. Nas et al.

Summary: This multi-center VF-waveform OHCA study demonstrated significantly lower AMSA in cases of underlying STEMI, with a more pronounced difference for inferior than for anterior STEMI. Further confirmatory studies are needed to investigate the impact of STEMI localization on the VF waveform, which may contribute to earlier diagnosis of STEMI during VF.

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Clinical paper Coronary angiography findings in patients with shock-resistant ventricular fibrillation cardiac arrest

J. Nas et al.

Summary: In OHCA patients with shock-resistant VF, acute coronary occlusions were more prevalent compared to non-shock-resistant VF, leading to worse clinical outcomes. Further confirmative studies are needed to explore this potential reversible therapeutic target.

RESUSCITATION (2021)

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Clinical and Angiographic Predictors of Mortality in Sudden Cardiac Arrest Patients Having Cardiac Catheterisation: A Single Centre Registry

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Angiographic characteristics and long-term prognostic impact of coronary artery disease in survivors after sudden cardiac arrest with a non-diagnostic electrocardiogram

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Coronary lesions in refractory out of hospital cardiac arrest (OHCA) treated by extra corporeal pulmonary resuscitation (ECPR)

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Predictive value of amplitude spectrum area of ventricular fibrillation waveform in patients with acute or previous myocardial infarction in out-of-hospital cardiac arrest

Michiel Hulleman et al.

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Article Critical Care Medicine

Epidemiology and outcomes from out-of-hospital cardiac arrests in England

Claire Hawkes et al.

RESUSCITATION (2017)

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Article Cardiac & Cardiovascular Systems

Coronary angiography findings in cardiac arrest patients with non-diagnostic post-resuscitation electrocardiogram: A comparison of shockable and non-shockable initial rhythms

Pedro Martinez-Losas et al.

WORLD JOURNAL OF CARDIOLOGY (2017)

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Article Cardiac & Cardiovascular Systems

Utility of the Ventricular Fibrillation Waveform to Predict a Return of Spontaneous Circulation and Distinguish Acute From Post Myocardial Infarction or Normal Swine in Ventricular Fibrillation Cardiac Arrest

Julia H. Indik et al.

CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY (2011)

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Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest Insights From the PROCAT (Parisian Region Out of Hospital Cardiac Arrest) Registry

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Acute coronary angiographic findings in survivors of out-of-hospital cardiac arrest

Zacharias Alexandros Anyfantakis et al.

AMERICAN HEART JOURNAL (2009)

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Review Critical Care Medicine

The epidemiology of out-of-hospital 'sudden' cardiac arrest

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RESUSCITATION (2002)

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