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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA systematic diagnostic and therapeutic algorithm, which includes urgent catheterization, following cardio-pulmonary resuscitation is feasible and is associated with improved patient outcome. This article presents results from a prospective study assessing a systematic approach to managing patients following resuscitation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECritical Care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECritical Care\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA systematic diagnostic and therapeutic algorithm, which includes urgent catheterization, following cardiopulmonary resuscitation is feasible and is associated with improved patient outcome. Hubertus von Korn, MD, Krankenhaus Hetzelstift, Neustadt\/Weinstrasse, Germany, presented results from a prospective study assessing a systematic approach to managing patients following resuscitation.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe survival rate after cardiac resuscitation is poor at approximately 8% [Nichol G et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2008]. Current guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death from the American College of Cardiology\/American Heart Association\/European Society of Cardiology recommend consideration of immediate coronary angiography in patients with postcardiac arrest for whom an acute coronary syndrome (ACS) is suspected [Zipes DP et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2006]. A systematic diagnostic and therapeutic approach, however, has not been tested.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe systematic approach studied consists of an electrocardiogram and echocardiogram performed in the emergency room, urgent cardiac catheterization with coronary angiography and left ventricular (LV) angiography, pulmonary angiography if the cause of arrest is unknown, computed tomography of the chest and the head, predefined laboratory tests (if cause is unknown), establishment of an intra-arterial balloon pump (IABP), hypothermia, and cardiac magnetic resonance imaging (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/12\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Diagnostic Algorithm Used Following Cardiopulmonary Resuscitation\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-702585211\u0022 data-figure-caption=\u0022Diagnostic Algorithm Used Following Cardiopulmonary Resuscitation\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/12\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/12\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/42\/12\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15349\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EDiagnostic Algorithm Used Following Cardiopulmonary Resuscitation\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECCT, coronary computed tomography; ECG, electrocardiogram; ICU, intensive care unit; MRI, magnetic resonance imaging.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from H von Korn, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EOver 5 years, 212 patients were enrolled in the protocol for the prospective study. The primary end point of the study was the Cerebral Performance Category Scale. The mean patient age was 66.7 years, men comprised 71.2% of the study population, and the mean LV ejection fraction was 42.9%. The mean time from first alert to arrival of the mobile emergency medical unit was 7.7 minutes, the mean time from first alert to time to arrival in the clinic was 50.1 minutes, and the mean time from first alert to cardiac catheterization was 76.6 minutes. The first detected rhythm was ventricular fibrillation in 99 patients (46.7%); critical bradycardia, electromechanical dissociation, or asystole in 96 (45.3%); and ventricular tachycardia in 5 (2.4%). The rhythm was not classified in 12 patients (5.7%).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ENinety percent of patients had a cardiac cause of their event (47.2% with an ACS and 42.9% with other cardiac causes). Other cardiac causes included cardiomyopathy (20.8%), lung embolism (3.8%), Tako-Tsubo cardiomyopathy (3.3%), and others (15.1%), which included coronary artery disease without non-ST or ST elevation (7.1%), and long-QT syndrome or early repolarization (2.8%). The 2 main noncardiac causes were intracerebral bleeding and sepsis. A significant coronary artery stenosis, defined as a percentage of diameter stenosis \u0026gt; 60%, was found in 130 (61.3%) and a percutaneous coronary intervention (PCI) was performed in 101 (47.6%) of these patients.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn the intensive care unit, 20 patients (9.4%) had IABP, 55 (25.9%) underwent hypothermia, and 23 (10.9%) had an implantable cardioverter defibrillator or pacemaker implanted. The survival rate was 35.9%, and 67 patients (31.8%) had a cerebral performance category scale of 1 or 2, indicating good cerebral performance or moderate cerebral disability.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn patients treated with PCI, a significant decrease in mortality was found for patients with restoration of TIMI 2 or 3 blood flow compared with TIMI 0 or 1 flow (65.4% vs 95.7%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .01). Mortality for patients treated with hypothermia was 52.7% compared with 68.2% for no hypothermia (\u003Cem\u003EP\u003C\/em\u003E = .04). There was a trend for neurologic benefit among patients treated with hypothermia: 40% in this group had a cerebral performance category scale of 1 or 2, compared with 28.9% not treated with hypothermia (\u003Cem\u003EP\u003C\/em\u003E = .05). Establishment of an IABP had no effect on mortality (\u003Cem\u003EP\u003C\/em\u003E = .6), which was 70.0% in those with and 63.6% in those without an IABP established.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/42\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzojpp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzojpp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}