Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
42 - Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
from Part IV - Therapy of sudden death
Published online by Cambridge University Press: 06 January 2010
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Part I Introduction
- Part II Basic science
- Part III The pathophysiology of global ischemia and reperfusion
- Part IV Therapy of sudden death
- 23 Prevention of sudden cardiac death
- 24 Sequence of therapies during resuscitation: application of CPR
- 25 Transthoracic defibrillation
- 26 Automated external defibrillators
- 27 Public access defibrillation
- 28 The physiology of ventilation during cardiac arrest and other low blood flow states
- 29 Airway techniques and airway devices
- 30 Manual cardiopulmonary resuscitation techniques
- 31 Mechanical devices for cardiopulmonary resuscitation
- 32 Invasive reperfusion techniques
- 33 Routes of drug administration
- 34 Adrenergic agonists
- 35 Vasopressin and other non-adrenergic vasopressors
- 36 Antiarrhythmic therapy during cardiac arrest and resuscitation
- 37 Acid–base considerations and buffer therapy
- 38 Cardiac arrest resuscitation monitoring
- 39 Special considerations in the therapy of non-fibrillatory cardiac arrest
- 40 Cardiocerebral resuscitation: a new approach to out-of-hospital cardiac arrest
- 41 Thrombolysis during resuscitation from cardiac arrest
- 42 Percutaneous coronary intervention (PCI) after successful reestablishment of spontaneous circulation and during cardiopulmonary resuscitation
- 43 Emergency medical services systems and out-of-hospital cardiac arrest
- 44 In-hospital resuscitation
- 45 Complications of CPR
- 46 Bringing it all together: state-of-the-art therapy for cardiac arrest
- Part V Postresuscitation disease and its care
- Part VI Special resuscitation circumstances
- Part VII Special issues in resuscitation
- Index
Summary
Introduction
Coronary artery disease represents the most important cause of out-of-hospital cardiac arrest. Immediate coronary angiography in patients after reestablishment of spontaneous circulation demonstrated angiographic evidence of coronary artery disease in 80% of patients, with the majority (90%) having significant obstructive stenoses of one or more coronary arteries. Experimental animal models have shown that coronary obstructions have a profound effect on the utility of cardiopulmonary resuscitation to perfuse the myocardium during cardiac arrest. We found that coronary diameter stenoses as little as 33% decreased distal perfusion by more than half (see Chapter 18 for more details). Postmortem examinations of sudden cardiac death victims indicate that unstable plaque with associated coronary thrombosis may be documented in more than 80% of the cases. Accordingly, acute coronary thrombotic events leading to critical narrowing or complete coronary obstruction and possibly distal microembolization may be a main trigger of sudden arrhythmic cardiac arrest.
Current strategy for management of acute coronary syndromes
Acute coronary syndrome (ACS), based on 12-lead electrocardiogram, is traditionally divided into evolving ST segment elevation acute myocardial infarction (STEMI) and unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) (Fig. 42.1). More than 90% of the patients with STEMI have a complete thrombotic occlusion of the epicardial part of one of the coronary arteries without adequate collateral flow to the distal part of the affected artery. The mechanisms of coronary obstruction in patients with UA/NSTEMI are more heterogeneous.
- Type
- Chapter
- Information
- Cardiac ArrestThe Science and Practice of Resuscitation Medicine, pp. 764 - 771Publisher: Cambridge University PressPrint publication year: 2007