July 13, 2015

So you are minding your own business when a 60 year old patient comes in after witnessed Out-Of-Hospital Cardiac Arrest (OHCA).  She had a witnessed arrest, good bystander CPR and the prehospital team shocked her out of ventricular fibrillation (vfib), intubated her and brought her in after 25 min of total down time and 15 min of CPR.  She is now neurologically stunned but with a stable blood pressure.  You get an EKG which shows normal sinus rhythm with non-specific ST and T wave changes(NSR NSSTTW changes)  basic labs, and are hunting for a source.  Labs, chest x-ray (CXR), point of care ultrasound (POCUS) by you doesn't reveal an alternate source to explain the arrest. You start hypothermic protocol and are thinking of sending her to the ICU.  Or maybe not?  What about the cath lab?  Your resident recalls some early data from European studies cathing some of these patients that trended towards favorable results and wants to know how you do things here?  The new ACC guidelines just published this month, July 2015 are here to answer that very question.