Urgent invasive coronary strategy and mild induced hypothermia in patients with resuscitated sudden cardiac arrest

Copyright © Polskie Towarzystwo Kardiologiczne INTRODUCTION Sudden cardiac arrest (SCA) remains the leading cause of death in developed countries, with an annual incidence ranging from 36 to 81 events per 100,000 inhabitants. According to the findings of post mortems and immediate coronary angiography, significant coronary artery disease may be documented in more than 70% of patients suffering from SCA [1, 2]. Following initial cardiocerebral resuscitation in the field, the re-establishment of spontaneous circulation (ROSC) is achieved in 40% to 60% of patients who are subsequently transferred to the emergency department. Because of typical delays in the ‘chain of survival’, up to 80% of patients remain comatose despite ROSC which pinpoints post-resuscitation brain injury. Its severity may ultimately vary from mild disability to permanent vegetative state and cannot be accurately prognosticated on hospital admission. Only a minority of ‘lucky losers’ with prompt initiation of chest compression and defibrillation, which is usually the case if emergency medical personnel are already present when cardiac arrest occurs, regain consciousness immediately after ROSC.