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TOMAHAWK: Difference between revisions
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(Created page with "==Clinical Question== <!-- This should be a PICO (Population, Intervention, Comparison, Outcome) style question. As an example, the ACCORD trial's clinical question is shown b...") |
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<!-- This should be a PICO (Population, Intervention, Comparison, Outcome) style question. As an example, the ACCORD trial's clinical question is shown below, but you should replace it with the clinical question addressed by the trial you're summarizing. --> | <!-- This should be a PICO (Population, Intervention, Comparison, Outcome) style question. As an example, the ACCORD trial's clinical question is shown below, but you should replace it with the clinical question addressed by the trial you're summarizing. --> | ||
In patients with out of hospital cardiac arrest who have been resuscitated but have no ST elevations post- | In adult patients (30+ years old) with out of hospital cardiac arrest who have been successfully resuscitated but have no ST elevations post-resuscitation, does immediate PCI improve survival? | ||
==Bottom Line== | ==Bottom Line== | ||
<!-- What is the one thing you would want to take away from this article? Again, the ACCORD's bottom line is shown below, but you should replace it with yours. --> | <!-- What is the one thing you would want to take away from this article? Again, the ACCORD's bottom line is shown below, but you should replace it with yours. --> | ||
There is no survival benefit for performing immediate PCI for resuscitated out of hospital arrest who have no post-resuscitation ST elevations | There is no survival benefit for performing immediate PCI for resuscitated out of hospital arrest who have no post-resuscitation ST elevations | ||
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<!-- Now write a succinct paragraph or two describing the major points in the article. Again, ACCORD's major points: --> | <!-- Now write a succinct paragraph or two describing the major points in the article. Again, ACCORD's major points: --> | ||
Early revascularization has demonstrated benefits in preserving ventricular function in those with an acute myocardial infarction; however this intervention is not risk-free. A RCT in patients with NSTEMI and a shockable rhythm showed no difference in 90-day survival with early vs delated angiography | |||
Reference: Dumas F, Bougouin W, Geri G, et al. Emergency percutaneous coronary intervention in post-cardiac arrest patients without ST-segment elevation pattern: insights from the PROCAT II Registry. JACC Cardiovasc Interv 2016;9:1011-8. | |||
Reference 5: prior study Lemkes JS, Janssens GN, van der Hoeven NW, et al. Coronary angiography after cardiac arrest without ST-segment | More than half of out of hospital cardiac arrests are attributable to acute coronary syndrome and ST elevations post-resuscitation suggest an correctable coronary lesion with demonstrated benefit of immediate PCI. Lack of ST elevations post-resuscitation may be secondary to non-cardiac causes, but the value of immediate angiography is unknown. | ||
Reference 5: prior study Lemkes JS, Janssens GN, van der Hoeven NW, et al. Coronary angiography after cardiac arrest without ST-segment elevation. N Engl J Med 2019;380:1397-407. | |||
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<!-- Jot down a quick bulleted list of inclusion criteria. Here are the ones from the ACCORD trial, but as before you should just replace them with the ones from the trial you're summarizing. --> | <!-- Jot down a quick bulleted list of inclusion criteria. Here are the ones from the ACCORD trial, but as before you should just replace them with the ones from the trial you're summarizing. --> | ||
* 30 years or older with out of hospital resuscitation of cardiac arrest without ST elevation | * 30 years or older, with out of hospital resuscitation of cardiac arrest of possible cardiac etiology, without ST elevation post-resuscitation | ||
* Shockable and unshockable rhythms included | * Shockable and unshockable rhythms included | ||
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* Requiring intervention for hemodynamic instability or electrical instability | * Requiring intervention for hemodynamic instability or electrical instability | ||
* In hospital arrest | * In hospital arrest | ||
* obvious non-cardiac etiology (TBI, primary metabolic derangement, intoxication, overt hemorrhage, respiratory failure in patients with known lung disease, suffocation, drowning) | |||
* pregnancy | |||
* participation in another intervention trial that may interfere with TOMAHAWK participation | |||
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==Funding== | ==Funding== | ||
* German Center For Cardiovascular Research | * German Center For Cardiovascular Research [clinicaltrials.gov NCT02750462] | ||
==Further Reading== | ==Further Reading== | ||
<references/> | <references/> | ||