New Developments in the Treatment of Acute Myocardial Infarction Associated with Out-of-Hospital Cardiac Arrest. A Review

Open access

Abstract

Out-of-hospital cardiac arrest (OHCA) occurring as the first manifestation of an acute myocardial infarction is associated with very high mortality rates. As in comatose patients the etiology of cardiac arrest may be unclear, especially in cases without ST-segment elevation on the surface electrocardiogram, the decision to perform or not to perform urgent coronary angiography can have a significant impact on the prognosis of these patients. This review summarises the current knowledge and recommendations for treating patients with acute myocardial infarction presenting with OHCA. New therapeutic measures for the post-resuscitation phase are presented, such as hypothermia or extracardiac life support, together with strategies aiming to restore the coronary flow in the resuscitation phase using intra-arrest percutaneous revascularization performed during resuscitation. The role of regional networks in providing rapid access to the hospital facilities and to a catheterization laboratory for these critical cardiovascular emergencies is described.

1. Go AS, Mozaffarian D, Roger VL, et al. Heart Disease and Stroke Statistics—2014 Update. Circulation. 2014;129:e28-e292. https://doi.org/10.1161/01.cir.0000441139.02102.80

2. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81:1479-1487. doi: 10.1016/j.resuscitation.2010.08.006.

3. Fukuda T, Ohashi-Fukuda N, Kondo Y, Sera T, Doi K, Yahagi N. Epidemiology, Risk Factors, and Outcomes of Out-of-Hospital Cardiac Arrest Caused by Stroke: A Population-Based Study. Medicine (Baltimore). 2016;95:e3107. doi: 10.1097/MD.0000000000003107.

4. Kitamura T, Kiyohara K, Sakai T, et al. Epidemiology and outcome of adult out-of-hospital cardiac arrest of non-cardiac origin in Osaka: a population-based study. BMJ Open. 2014;4:e006462. doi:10.1136/bmjopen-2014-006462.

5. Hawkes C, Booth S, Ji C, et al. Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation. 2017;110:133-140. doi: 10.1016/j.resuscitation.2016.10.030.

6. Mawani M, Kadir MM, Azam I, et al. Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study. BMC Emergency Medicine. 2016;16:1. doi: 10.1186/s12873-016-0093-2.

7. Safdar B, Stolz U, Stiell IG. Differential survival for men and women from out-of-hospital cardiac arrest varies by age: results from the OPALS study. Acad Emerg Med. 2014;21:1503-1511. doi: 10.1111/acem.12540.

8. Chen HY, Gore JM, Lapane KL, et al. A 35-Year Perspective (1975 to 2009) into the Long-Term Prognosis and Hospital Management of Patients Discharged from the Hospital After a First Acute Myocardial Infarction. Am J Cardiol. 2015;116:24-29. doi: 10.1016/j.amjcard.2015.03.035.

9. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35:2950-2959. doi: 10.1093/eurheartj/ehu299.

10. Goraya TY, Jacobsen SJ, Kottke TE, Frye RL, Weston SA, Roger VL. Coronary heart disease death and sudden cardiac deaths: a 20-year population-based study. Am J Epidemiol. 2003;157:763-770.

11. Aso S, Imamura H, Sekiguchi Y, et al. Incidence and mortality of acute myocardial infarction. A population-based study including patients with out-of-hospital cardiac arrest. Int Heart J. 2011;52:197-202.

12. Noc M, Fajadet J, Lassen JF, et al. Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European association for percutaneous cardiovascular interventions (EAPCI)/stent for life (SFL) groups. EuroIntervention. 2014;10:31-37. doi: 10.4244/EIJV10I1A7.

13. Ostenfeld S, Lindholm MG, Kjaergaard J, et al. Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction. Resuscitation. 2015;87:57-62. doi: 10.1016/j.resuscitation.2014.11.010.

14. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541-2619. doi: 10.1093/eurheartj/ehu278.

15. Noc M, Fajadet J, Lassen JF, et al. Invasive Coronary Treatment Strategies for Out-Of-Hospital Cardiac Arrest: A Consensus Statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups. EuroIntervention. 2014;10:31-37. doi: 10.4244/EIJV10I1A7.

16. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78-e140. doi: 10.1016/j.jacc.2012.11.019.

17. Anyfantakis ZA, Baron G, Aubry P, et al. Acute coronary Angiographic findings in survivors of out-of-hospital cardiac arrest. Am Heart J. 2009;157:312-318. doi: 10.1016/j.ahj.2008.09.016.

18. Randhawa VK, Nagpal AD, Lavi S. Out-of-Hospital Cardiac Arrest and Acute Coronary Syndromes: Reviewing Post-Resuscitation Care Strategies. Can J Cardiol. 2015;31:1477-1480. doi: 10.1016/j.cjca.2015.05.001.

19. Waldo SW, Chang L, Strom JB, O’Brien C, Pomerantsev E, Yeh RW. Predicting the Presence of an Acute Coronary Lesion Among Patients Resuscitated From Cardiac Arrest. Circ Cardiovasc Interv. 2015;8. doi: 10.1161/CIRCINTERVENTIONS.114.002198.

20. Kern KB. Importance of invasive interventional strategies in resuscitated patients following sudden cardiac arrest. Interv Cardiol. 2011;3:649–661. doi:10.2217/ica.11.79.

21. Kern KB, Lotun K, Patel N, et al. Outcomes of Comatose Cardiac Arrest Survivors With and Without ST-Segment Elevation Myocardial Infarction: Importance of Coronary Angiography. JACC Cardiovasc Interv. 2015;8:1031-1040. doi: 10.1016/j.jcin.2015.02.021.

22. Nikolaou NI, Arntz HR, Bellou A, et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation. 2015;95:264-277. doi: 10.1016/j.resuscitation.2015.07.030.

23. Kern KB. Optimal treatment of patients surviving out-of-hospital cardiac arrest. JACC Cardiovasc Interv. 2012;5:597-605. doi: 10.1016/j.jcin.2012.01.017.

24. Dumas F, Cariou A, Manzo-Silberman S, et al. 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. Circ Cardiovasc Interv. 2010;3:200-207. doi: 10.1161/CIRCINTERVENTIONS.109.913665.

25. Bangalore S, Hochman JS. A routine invasive strategy for out-of-hospital cardiac arrest survivors: are we there yet? Circ Cardiovasc Interv. 2010;3:197-199. doi: 10.1161/CIRCINTERVENTIONS.110.957241.

26. Barcan A, Kovacs I, Blendea C, Orzan M, Chitu M. Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome. Journal of Cardiovascular Emergencies. 2015;1:68-74. doi: 10.1515/jce-2015-0010.

27. Monsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015;95:1-80. doi: 10.1016/j.resuscitation.2015.07.038.

28. Patel N, Patel NJ, Macon CJ, et al. Trends and Outcomes of Coronary Angiography and Percutaneous Coronary Intervention After Out-of-Hospital Cardiac Arrest Associated With Ventricular Fibrillation or Pulseless Ventricular Tachycardia. JAMA Cardiol. 2016;1:890-899. doi: 10.1001/jamacardio.2016.2860.

29. Geri G, Dumas F, Bougouin W. Immediate Percutaneous Coronary Intervention Is Associated With Improved Short- and Long-Term Survival After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv. 2015;8. doi: 10.1161/CIRCINTERVENTIONS.114.002303.

30. Geri G, Dumas F, Cariou A. Should we perform a coronary angiography in all cardiac arrest survivors? Curr Opin Crit Care. 2014;20:273-279. doi: 10.1097/MCC.0000000000000093.

31. Bro-Jeppesen J, Kjaergaard J, Wanscher M, et al. Emergency coronary angiography in comatose cardiac arrest patients: do real-life experiences support the guidelines? European Heart Journal Acute Cardiovascular Care. 2012;1:291-301. doi:10.1177/2048872612465588.

32. Kagawa E, Dote K, Kato M, et al. Should we emergently revascularize occluded coronaries for cardiac arrest?: rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation. 2012;126:1605-1613. doi: 10.1161/CIRCULATIONAHA.111.067538.

33. Kagawa E, Dote K, Kihara Y. Percutaneous coronary intervention for postcardiac arrest syndrome. Curr Opin Cardiol. 2013;28:689-694. doi: 10.1097/HCO.0b013e32836553b7.

34. Bedreag OH, Papurica M, Rogobete AF, Sandesc D. Influence of Hypothermia on the Clinical and Molecular Status of a Freshwater Drowning Victim with Severe Trauma. A Case Report. Journal of Interdisciplinary Medicine. 2015;1:186-188. doi: 10.1515/jim-2016-0029.

35. Kerans V, Espinoza A, Skulstad H, Halvorsen PS, Edvardsen T, Bugge JF. Systolic left ventricular function is preserved during therapeutic hypothermia, also during increases in heart rate with impaired diastolic filling. Intensive Care Med Exp. 2015;3:41. doi: 10.1186/s40635-015-0041-6.

36. Gunn AJ, Thoresen M. Hypothermic neuroprotection. NeuroRx. 2006;3:154–169. doi: 10.1016/j.nurx.2006.01.007.

37. Froehler MT, Geocadin RG. Hypothermia for neuroprotection after cardiac arrest: mechanisms, clinical trials and patient care. J Neurol Sci. 2007;261:118-126. doi: 10.1016/j.jns.2007.04.042.

38. Dumas F, Grimaldi D, Zuber B, et al. Is Hypothermia After Cardiac Arrest Effective in Both Shockable and Nonshockable Patients? Circulation. 2011;123:877-886. doi: 10.1161/CIRCULATIONAHA.110.987347.

39. Chan PS, McNally B, Tang F, Kellermann A, CARES Surveillance Group. Recent Trends in Survival from Out-of-Hospital Cardiac Arrest in the United States. Circulation. 2014;130:1876-1882. doi: 10.1161/CIRCULATIONAHA.114.009711.

40. Testori C, Sterz F, Behringer W, et al. Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms. Resuscitation. 2011;82:1162–1167. doi: 10.1016/j.resuscitation.2011.05.022.

41. Hollenberg J, Herlitz J, Lindqvist J, et al. Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew–witnessed cases and bystander cardiopulmonary resuscitation. Circulation. 2008;118:389-396. doi: 10.1161/CIRCULATIONAHA.107.734137.

42. Vaahersalo J, Hiltunen P, Tiainen M, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Med. 2013;39:826–837. doi: 10.1007/s00134-013-2868-1.

43. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33 C versus 36 C after cardiac arrest. N Engl J Med. 2013;369:2197-2206. doi: 10.1056/NEJMoa1310519.

44. Ibrahim K, Christoph M, Schmeinck S, et al. High rates of prasugrel and ticagrelor non-responder in patients treated with therapeutic hypothermia after cardiac arrest. Resuscitation. 2014;85:649-656. doi: 10.1016/j.resuscitation.2014.02.004.

45. Donnino MW, Andersen LW, Berg KM, et al. Temperature Management After Cardiac Arrest An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2016;98:97-104. doi: 10.1016/j.resuscitation.2015.09.396.

46. Penela D, Magaldi M, Fontanals J, et al. Hypothermia in acute coronary syndrome: brain salvage versus stent thrombosis? J Am Coll Cardiol 2013;61:686-687. doi: 10.1016/j.jacc.2012.10.029.

47. Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015 Section 5 of the European Resuscitation Council Guidelines for Resuscitation. Intensive Care Med. 2015;41:2039-2056. doi: 10.1007/s00134-015-4051-3.

48. Rab T, Kern KB, Tamis-Holland JE, et al. Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient. J Am Coll Cardiol. 2015;66:62-73. doi: 10.1016/j.jacc.2015.05.009.

49. Mooney MR, Unger BT, Boland LL, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest: evaluation of a regional system to increase access to cooling. Circulation. 2011;124:206-214. doi: 10.1161/CIRCULATIONAHA.110.986257.

50. Irisawa T, Vadeboncoeur TF, Karamooz M, et al. Duration of Coma in Out-of-Hospital Cardiac Arrest Survivors Treated With Targeted Temperature Management. Ann Emerg Med. 2017;69:36-43. doi: 10.1016/j.annemergmed.2016.04.021.

51. Maznyczka AM, Gershlick AH. Therapeutic hypothermia in patients with out-of-hospital arrest. Heart. 2015. doi:10.1136/heartjnl-2014-307411.

52. Joffre J, Varenne O, Bougouin W, Rosencher J, Mira JP, Cariou A. Stent thrombosis: an increased adverse event after angioplasty following resuscitated cardiac arrest. Resuscitation. 2014;85:769-773. doi: 10.1016/j.resuscitation.2014.02.013.

53. Shah N, Rahul C, Kathan M, et al. Therapeutic Hypothermia and Stent Thrombosis: A Nationwide Analysis. JACC Cardiovasc Interv. 2016 Sep 12;9(17):1801-11. doi: 10.1016/j.jcin.2016.06.052.

54. Kang IS, Fumiaki I, Pyun WB. Therapeutic Hypothermia for Cardioprotection in Acute Myocardial Infarction. Yonsei Medical Journal. 2016;57:291-297. doi:10.3349/ymj.2016.57.2.291.

55. Schenone AL, Cohen A, Patarroyo G. Therapeutic hypothermia after cardiac arrest: A systematic review/meta-analysis exploring the impact of expanded criteria and targeted temperature. Resuscitation. 2016;108:102-110. doi: 10.1016/j.resuscitation.2016.07.238.

56. Tissier R, Ghaleh B, Cohen MV, Downey JM, Berdeaux A. Myocardial protection with mild hypothermia. Cardiovasc Res. 2012;94:217-225. doi: 10.1093/cvr/cvr315.

57. Bernard S. Hypothermia after cardiac arrest: expanding the therapeutic scope. Crit Care Med. 2009;37(7Suppl):S227-S233. doi: 10.1097/CCM.0b013e3181aa5d0c.

58. Grunau BE. Prehospital initiation of mild therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA): where are we now? CJEM. 2015;17:227-230. doi: 10.1017/cem.2015.32.

59. Lyon R. Therapeutic hypothermia post out-of-hospital cardiac arrest - more questions than answers? Crit Care. 2011;15:151. doi: 10.1186/cc10123.

60. Benedek T, Marton-Popovici M, Glogar D. Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction — a Critical Approach for a Critical Condition. The Journal of Critical Care Medicine. 2016;1;2:164-174. doi: 10.1515/jccm-2016-0025.

61. Sharma AS, Pijls RWM, Weerwind PW, et al. Out-of-hospital cardiac arrest: the prospect of E-CPR in the Maastricht region. Netherlands Heart Journal. 2016;24:120-126. doi:10.1007/s12471-015-0782-6.

62. Mosier JM, Kelsey M, Raz Y, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Critical Care. 2015;19:431. doi:10.1186/s13054-015-1155-7.

63. Ahn C, Kim W, Cho Y, Choi K-S, Jang B-H, Lim TH. Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis. Scientific Reports. 2016;6:34208. doi:10.1038/srep34208.

64. Stub D, Bernard S, Duffy SJ, Kaye DM. Post cardiac arrest syndrome: a review of therapeutic strategies Circulation. 2011;123:1428-1435. doi: 10.1161/CIRCULATIONAHA.110.988725.

65. Pagani FD, Aaronson KD, Swaniker F, Bartlett RH. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann Thorac Surg. 2001;71(3Suppl):S77-S81.

66. Dalle Ave AL, Shaw DM, Gardiner D. Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest—An ethical analysis of an unresolved clinical dilemma. Resuscitation. 2016;108:87-94. doi: 10.1016/j.resuscitation.2016.07.003.

67. Reynolds JC, Frisch A, Rittenberger JC, et al. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation. 2013;128:2488-94. doi:10.1161/CIRCULATIONAHA.113.002408.

68. Radsel P, Knafelj R, Kocjancic S, et al. Angiographic characteristics of coronary disease and postresuscitation electrocardiograms in patients with aborted cardiac arrest outside a hospital. Am J Cardiol. 2011;108:634-638. doi: 10.1016/j.amjcard.2011.04.008.

69. Benedek I, Gyongyosi M, Benedek T. A prospective regional registry of ST-elevation myocardial infarction in Central Romania: Impact of the Stent for Life Initiative recommendations on patient outcomes. Am Heart J. 2013;166:457-465. doi: 10.1016/j.ahj.2013.03.033.

70. Jacobs AK. Regional Systems of Care for Patients With ST-Elevation Myocardial Infarction Circulation. 2007;116:689-692. doi: 10.1161/CIRCULATIONAHA.107.720946

71. Nichol G, Aufderheide TP, Eigel B, et al. Regional Systems of Care for Out-of-Hospital Cardiac Arrest. Circulation. 2010;121:709-729. https://doi.org/10.1161/CIR.0b013e3181cdb7db.

72. McNally B, Robb R, Mehta M, et al. Centers for Disease Control and Prevention. Out-of-hospital cardiac arrest surveillance—Cardiac Arrest Registry to Enhance Survival (CARES). MMWR Surveill Summ. 2011;60(SS08):1-19.

73. Hasselqvist-Ax I, Riva G, Herlitz J, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2307-2315. doi: 10.1056/NEJMoa1405796.

74. Callaway CW, Donnino MW, Fink EL, et al. Part 8: Post–Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18Suppl2):S465-S$82. doi: 10.1161/CIR.0000000000000262.

75. Azeli Y, Barbería E, Jiménez-Herrera M, et al. The ReCaPTa Study - a Prospective out of Hospital Cardiac Arrest Registry Including Multiple Sources of Surveillance for the Study of Sudden Cardiac Death in the Mediterranean Area. Scand J Trauma Resusc Emerg Med. 2016;24:127. doi: 10.1186/s13049-016-0309-1.

76. Kajino K, Iwami T, Daya M, et al. Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest. Resuscitation. 2010;81:549-554. doi: 10.1016/j.resuscitation.2010.02.008.

77. Hwang WS, Park JS, Kim SJ, Hong YS, Moon SW, Lee SW. A system-wide approach from the community to the hospital for improving neurologic outcomes in out-of-hospital cardiac arrest patients. Eur J Emerg Med. 2015. doi: 10.1097/MEJ.0000000000000313.

78. Yamada T, Kitamura T, Hayakawa K, et al. Rationale, design, and profile of Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan. Journal of Intensive Care. 2016;4:10. doi:10.1186/s40560-016-0128-5.

79. Ringh M, Rosenqvist M, Hollenberg J, et al. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med. 2015;372:2316-2325. doi: 10.1056/NEJMoa1406038.

80. Kern KB. Usefulness of cardiac arrest centers — extending lifesaving post-resuscitation therapies: the Arizona experience. Circ J. 2015;79:1156-1163. doi: 10.1253/circj.CJ-15-0309.

81. Donnino MW, Rittenberger JC, Gaieski D, et al. The development and implementation of cardiac arrest centers. Resuscitation. 2011;82:974-978. doi:10.1016/j.resuscitation.2011.03.021.

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 341 202 23
PDF Downloads 133 93 11