Of 269 patients, 45% received early cardiac catheterization (either at hospital admission or during hypothermia treatment), 15% received catheterization later during hospitalization, and 39% did not receive catheterization. The early-catheterization group was more likely to be in shock on admission and to receive mechanical support (usually with an intraaortic balloon pump), aspirin, antithrombin agents, and glycoprotein IIb/IIIa inhibitors than patients who received later or no catheterization. Acute coronary occlusion was present in 26% of the early-catheterization group and 29% of the late-catheterization group.

Overall hospital mortality rate was 43.5%. Patients who received early catheterization were significantly more likely to survive than those who received late or no catheterization (66% vs. 49%) and to have good neurologic outcome (61% vs. 45%). Differences in outcomes were even more striking when the early-catheterization group was compared to the no-catheterization group.

COMMENT

Given that the post-resuscitation electrocardiogram may be unreliable and ST-elevation is insensitive for predicting acute coronary occlusion, it is reasonable to consider immediate cardiac catheterization for comatose survivors of arrhythmia-induced cardiac arrest, even in the absence of STEMI.