Saturday, 2 April 2016

Cardiac catheterization for survivors of out of hospital cardiac arrest; on shaky ground?

This well done review and meta-analysis examined the current evidence in support of cardiac catheterization for survivors of out of hospital cardiac arrest.

Let’s cut right to the chase.

For the primary outcome, the acute catheterization group was clearly superior with almost 60% vs. 30% in hospital survival (Odds ratio 2.77 95% CI 2.06-3.72). Survival with good neurological outcome was nearly the same.

Of course the authors conclude that early coronary angiography in patients following OHCA is associated with improved outcomes... which is true of course.

But is all of the evidence on shaky ground?

Perhaps.

All of the studies included in this meta-analysis were observational in nature. From a pure evidence based standpoint, it is possible that all of the difference in survival could be due to selection bias and confounding rather than the real efficacy of the intervention.

All observational studies are challenged by these issues. The best way around this is to conduct a properly blinded and randomized clinical trial. Of course this is not always ethical or feasible.

But there are those who believe there is enough clinical equipoise to warrant a proper experimental trial. A quick look at www.clinicaltrials.gov demonstrates several centres (USA, Spain, Sweden, & Canada) are currently on to it. Let’s hope we get some better data.

Despite lack of definitive efficacy I’m not about to jump out of an airplane without a parachute. Currently, I think it is very reasonable to be aggressive with early angiography in suitable patients. This is especially for those with STEMI’s and/or presumed primary cardiac cause of arrest. 


In the future, let’s hope the ground doesn’t start shaking. 


Covering:

Camuglia AC, Randhawa VK, Lavi S, et al. Cardiac catheterization in associated with superior outcomes for survivors of out of hospital cardiac arrest: Review and meta-analysis. Resuscitation 2014;85:1533-1540. 





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