According to the American College of Cardiology(ACC), based on guidelines published this month, there is a shift in the post cardiac arrest care algorithm. The prior guidelines from 2013 have a Class I recommendation for performing immediate heart catheterization for PCI for the management of comatose patients with STEMI after out of hospital cardiac arrest. Prior to now there were no recommendations for post arrest patients who did not have STEMI. The ACC guidelines now push for immediate catheterization for patient’s who do not have unfavorable resuscitation features (discussed in the table provided) after discussion with our cardiology colleagues. This may drastically change post-arrest care as the majority of post-arrest patients do not have STEMI on EKG. The data supporting catheterizing non-stemi post-arrest patients is more limited, but data suggests that about 25% of patient’s without STE will have an occlusion upon cath and about 60% will have significant obstructive lesions. One study evaluating early invasive treatment in the management of non-stemi post-arrest patients found that there was better long term survival (60% vs 40.4% [p = 0.005]) and a more favorable neurological outcome (60.0% vs 39.7% [p = 0.004]) when implementing the invasive strategy.
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