For cardiac arrest, cath lab or ICU?

It’s a $5.7 million question. At least that’s how much Demetri Yannopoulos, MD, just received from the National Institutes of Health to research how best to treat patients who have been resuscitated after sudden cardiac arrest.

It’s among the most harrowing medical conditions: the moment when a person’s heart and lungs stop without warning.

Cardiac arrest affects more than 350,000 people outside of a hospital each year. It’s critical that treatment begin in the field. Upon arrival, emergency medical personnel administer shocks via automated external defibrillator and deliver CPR. These tactics help the heart regain a normal rhythm at which point the person is rushed to the hospital.

Historically patients would then be admitted to an intensive care unit (ICU) for additional care. After further evaluation, they are often transferred to a catheterization laboratory where cardiologists can address the root cause of the sudden cardiac arrest.

But Yannopoulos, an interventional cardiologist and medical director of the Minnesota Resuscitation Consortium within the University of Minnesota Medical School, is testing emerging evidence that suggests immediate access to the catheterization laboratory significantly increases survival.

“For decades, physicians have treated cardiac arrest the same way, acting as though there was no room for improvement,” he said. “But, that’s not how clinical breakthroughs are discovered, so our team went back to the drawing board to figure out how we might improve survival.”

Yannopoulos and colleagues published a clinical protocol in the Journal of the American Heart Association in January 2016, indicating that when patients in Greater Minneapolis-St. Paul area are resuscitated from a shockable rhythm and gain early access to cath labs, they have 65 percent survival rate, compared to 50 percent survival under the traditional response to cardiac arrest.

While the published clinical protocol showed that early access is associated with higher neurologically intact survival, patient selection biases could not be excluded. Care providers involved in the study were able to select the patients that would receive immediate cath lab treatment, meaning it was not random.

This NIH grant will fund a five-year, randomized trial across five states and 20 hospitals, offering a clearer understanding of cardiac arrest best practices and the potential benefits of this new approach.

“After looking at our previous data, we think a larger randomized trial will be helpful in determining an accurate survival rate,” Yannopoulos said. “We hope for 10 to 15 percent increase [in survival]. That’s a lot of lives that will benefit from a new approach.”

https://twin-cities.umn.edu/node/263126
University of Minnesota, Twin Cities
06/27/2018