Abstract 9160: Epinephrine-Dominant versus Non-Epinephrine Dominant Resuscitation for In-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jennifer W Chou ◽  
Amy Lin ◽  
Juan Toledo ◽  
Gabriel Wardi ◽  
Katrina Derry ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Diastolic Pressure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cerebral Performance Category ◽  
Myocardial Oxygen Demand ◽  
Coronary Perfusion ◽  
Dose Ratio ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Vasopressors are used during CPR to increase arterial resistance and aortic diastolic pressure, improving coronary perfusion and likelihood of ROSC. In comparison to epinephrine, vasopressin remains effective in an acidemic environment, has favorable cerebral perfusion, and does not directly increase myocardial oxygen demand. Studies comparing epinephrine and vasopressin report variable ROSC, survival, and neurological outcome. Most studies used few vasopressin doses and it is unclear whether greater vasopressin use leads to clinical benefit. Hypothesis: We hypothesized that a non-epinephrine dominant CPR approach with vasopressin would lead to greater ROSC than an epinephrine-dominant approach. Methods: This was a retrospective, single-center study conducted at an 800-bed academic medical center. All first cardiac arrests among adult inpatients between Jan 2018 and Mar 2021 were screened, and those with at least 2 vasopressor doses used were included. Patients who received epinephrine-dominant resuscitation (epinephrine-to-vasopressin dose ratio >2 or CPR using only epinephrine) were compared to patients who received a non-epinephrine dominant approach (epinephrine-to-vasopressin dose ratio ≤2). The incidence of ROSC was analyzed using a Chi-squared test where p <0.05 was considered significant. Secondary outcomes included survival to discharge with favorable neurologic outcome, survival to discharge, and Cerebral Performance Category scores. Results: Of 663 in-hospital cardiac arrests screened, 264 were included. Two hundred twenty-eight (86%) presented with PEA/asystole as the initial rhythm, and the most common etiologies were circulatory (41%) and respiratory (26%). The epinephrine-dominant arm achieved ROSC in 89 (66%) patients compared to 87 (67%) patients in the non-epinephrine dominant arm (RR 0.99, 95% CI 0.84-1.18, p=0.93). Survival to discharge was higher in the epinephrine-dominant arm (25% vs 15%, p=0.04). Conclusion: There was no difference in ROSC between epinephrine-dominant and non-epinephrine dominant resuscitation for adult in-hospital cardiac arrest. Future studies should examine the impact of non-epinephrine dominant CPR on long term neurologic outcomes.

Abstract 122: Effects of Early Administration of Argatroban on CPR Quality in Porcine Model of Prolonged Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jensyn J VanZalen ◽  
Annie G Phillips ◽  
Stephen L Harvey ◽  
Joseph E Hill ◽  
Olivia L Pak ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Porcine Model ◽  
Diastolic Pressure ◽  
Randomized Study ◽  
Coronary Perfusion ◽  
Hemodynamic Parameters ◽  
Early Administration ◽  
Intravascular Thrombosis ◽  
Arterial Blood ◽  
The Impact

Background: The effectiveness of CPR declines over time during prolonged cardiac arrest (CA). Intravascular thrombosis may be a contributing factor. As part of a larger study examining antithrombotic therapy in a porcine model of prolonged CA, the impact of early administration of argatroban on CPR hemodynamics is reported. Hypothesis: Early administration of argatroban during CPR improves the quality of goal-directed CPR (gdCPR). Methods: In a blinded and randomized study, 48 swine (40±5kg) underwent an 8min untreated period of ventricular fibrillation CA followed by a gdCPR protocol for 30min (total arrest time 38min). Manual and mechanical chest compressions with the use of an impedance threshold device (ITD) were introduced to maintain end-tidal CO 2 (Et-CO 2 ) >20mmHg. Argatroban (350mg/kg) or placebo (20mL NSS) were administered to respective groups (n=24 per group) 12mins after initiation of CA. Et-CO 2 , coronary perfusion pressure (CPP), end-diastolic pressure (EDP), and intracranial pressure (ICP) were monitored continuously. Averages were taken over the course of gdCPR for hemodynamic parameters. Arterial blood gases (ABGs) were obtained at the end of gdCPR. Analysis between groups was performed using an unpaired t-test (significance = p <0.05). Results: Average hemodynamic parameters were not statistically different between argatroban vs. placebo groups (Et-CO 2 22.6±6.7 vs. 21.5±5.9 mmHg; EDP 25.6±10.7 vs. 23.7±9.6 mmHg; ICP 25.7±2.0 vs.20.9±2.7 cmH 2 O; CPP 8.7±11.2 vs. 7.0±11.2 mmHg). Final ABG values were also not statistically different between argatroban vs. placebo groups (pH 7.23±0.1 vs. 7.23±0.2; PaO 2 187.4±146.3 vs. 132.2±187.4 mmHg; PaCO 2 38.8±16.6 vs. 43.0±26.1 mmHg; lactate 8.5±1.7 vs. 8.8±1.4 mmol/L). Conclusion: These results demonstrate that early administration of argatroban during CPR did not have a significant effect on gdCPR quality in a porcine model of prolonged CA.

scholarly journals Impact of Cardiopulmonary Resuscitation Duration on the Neurological Outcomes of Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
HISSAH ALBINALI ◽  
Arwa Alumran ◽  
Saja AlRayes
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Bivariate Analysis ◽  
Neurological Outcomes ◽  
Risk Of Death ◽  
Secondary Hospital ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background: Patients experiencing cardiac arrest outside medical facilities are at greater risk of death and might have negative neurological outcomes. Cardiopulmonary resuscitation duration affects neurological outcomes of such patients, which suggests that duration of CPR may be vital to patient outcomes.Objectives: The study aims to evaluate the impact of cardiopulmonary resuscitation duration on neurological outcome of patients who have suffered out-of-hospital cardiac arrest.Methods: Data were collected from emergency cases handled by a secondary hospital in industrial Jubail, Saudi Arabia, between 2015 and 2020. There were 257 out-of-hospital cardiac arrest cases, 236 of which resulted in death.Results: Bivariate analysis showed no significant association between cerebral performance category (CPC) outcomes and duration of CPR, gender and cause of death whereas there is statistically significant between CPC and age. (p = 0.001). However, a good CPC outcome was reported with a (mean) limited duration of 8.1 min of CPR; whereas, poor CPC outcomes were associated with prolonged periods of CPR, 13.2 min (mean). Similarly, youthfulness was associated with good CPC outcomes as revealed by the mean age of 5.8 years, whereas a mean rank of 14.9 years was aligned with a poor CPC outcome.Conclusion: Cardiopulmonary Resuscitation Duration out-of-hospital cardiac arrest does not significantly influence the patient neurological outcome in the current study hospital. Other variables may have a more significant effect.

Abstract 268: Evaluation of the Abdominal Aortic and Junctional Tourniquet as an Adjunct to Chest Compressions in a Swine Model of Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jason Rall ◽  
Chris Hewitt ◽  
Matthew Pombo ◽  
Maria Castaneda ◽  
Perry Blough
Keyword(s):  
Cardiac Arrest ◽  
Repeated Measures ◽  
Life Support ◽  
Diastolic Pressure ◽  
Laboratory Animals ◽  
Swine Model ◽  
Coronary Perfusion ◽  
Chest Compressions ◽  
Abdominal Aortic ◽  
Hospital Cardiac Arrest

Introduction: Overall success in treating out-of-hospital cardiac arrest using traditional chest compressions is low. The abdominal aortic and junctional tourniquet (AAJT) is a device with a wedge-shaped air bladder that can be used to occlude the descending aorta at the level of bifurcation. In addition to shunting blood away from the lower extremities, this device may increase pleural pressures by inhibiting movement of the diaphragm during compressions. We have previously shown that the addition of an AAJT to mechanical chest compression leads to an increase in rate of survival in a model of traumatic cardiac arrest. Hypothesis: This study was designed to determine if application of the AAJT would lead to more effective chest compressions as measured by an increased rate of return of spontaneous circulation (ROSC) and hemodynamic parameters. Methods: Yorkshire swine (n=6 per group) underwent general anesthesia and instrumentation. Ventricular fibrillation was electrically induced using spinal needles placed in contact with the left ventricle. After eight minutes of arrest, chest compressions were initiated. Animals were then allocated into groups with or without the AAJT. Following a total of ten minutes of compressions, the animals entered into a ten-minute advanced cardiac life support phase. Results: A ROSC was not achieved in either group. No significant differences were observed with coronary perfusion pressure or end tidal CO 2 . However, the AAJT group had a significantly higher carotid diastolic pressure and higher blood flow in the carotid as compared with repeated-measures ANOVA (p = 0.016 and 0.028 respectively). Conclusion: The AAJT did not confer a survival advantage during chest compressions in our swine model of cardiac arrest. However, while the AAJT was in place, improvement was observed in some measures of CPR efficacy. Disclaimer: The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components. The experiments reported herein were conducted according to the principles set forth in the National Institute of Health Publication No. 80-23, Guide for the Care and Use of Laboratory Animals and the Animal Welfare Act of 1966, as amended.

Abstract 9740: Factors Associated With Performing Urgent Coronary Angiography in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
David H Lam ◽  
Lauren M Glassmoyer ◽  
Roger B Davis ◽  
Donald E Cutlip ◽  
Michael W Donnino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Medical Center ◽  
Academic Medical Center ◽  
Do Not Resuscitate ◽  
Factors Associated ◽  
Shockable Rhythm ◽  
History Of ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and is most commonly caused by cardiovascular disease. Current guidelines recommend urgent coronary angiography (UCA) if ST-elevation myocardial infarction (STEMI) or high suspicion of acute myocardial infarction exist. Some have advocated for UCA in all OHCA without an obvious non-cardiac cause of arrest. The reasons for large clinical variation in performance of UCA in OHCA are not well understood. Objective: We sought to identify factors associated with performing UCA in OHCA. Methods: A retrospective chart review was conducted on 535 consecutive cardiac arrest patients who achieved return of spontaneous circulation (ROSC) and were admitted at a tertiary academic medical center from January 2008 to August 2014. Exclusion criteria included in-hospital cardiac arrests (201), outside hospital UCA (8), and lack of medical records (1). Univariable analysis followed by multivariable forward selection forcing age and gender were used to determine correlates of performing UCA, defined as within 6 hours of presentation. Results: Out of 325 resuscitated OHCA patients (mean age, 64; women, 35%), 69 were taken to UCA. Factors associated with performing UCA were history of coronary artery disease (CAD) (OR 2.76, 95% CI 1.22-6.28), initial shockable rhythm (OR 3.04, 95% CI 1.31-7.06), following commands post-ROSC (OR 2.77, 95% CI 1.06-7.25), and STEMI (OR 15.17, 95% CI 6.57-35.04). Increasing age (OR 0.97, 95% CI 0.95-0.999) and obvious non-cardiac cause of arrest (OR 0.10, 95% CI 0.03-0.37) were negatively associated. Gender, prior stroke, dementia, bystander cardiopulmonary resuscitation, hypotension, contraindication to anticoagulant, presenting from nursing home or rehabilitation, do not resuscitate order prior to admission, non-English primary language, and presenting during off-hours were not associated with the decision for UCA. Conclusions: In resuscitated out-of-hospital cardiac arrest patients, history of CAD, shockable rhythm, ability to follow commands, and STEMI were associated with performing urgent coronary angiography. Older patients and those with an obvious non-cardiac cause of arrest were less likely to receive coronary angiography.

Abstract 11233: A Trigger and Response System for Preventing Cardiac Arrest in the Intensive Care Unit

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ari Moskowitz ◽  
Katherine Berg ◽  
Michael N Cocchi ◽  
Anne V Grossestreuer ◽  
Lakshman Balaji ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Arrest Rate ◽  
Academic Medical ◽  
Slope Change ◽  
Time Series Approach ◽  
A Prospective Study ◽  
The Impact

Background: Although patients in the ICU are closely monitored, some ICU cardiac arrest events may be preventable. In this study we sought to reduce the rate of ICU cardiac arrests. Methods: This was a prospective study of a novel clinical trigger and response tool deployed in the ICUs of a single, tertiary academic medical center. An interrupted time series approach was used to assess the impact of the tool on ICU cardiac arrests. Results: Forty-three patients experienced an ICU cardiac arrest in the pre-intervention epoch (6.79 arrests per 1000 discharges) and 59 patients experienced an ICU cardiac arrest in the intervention epoch (7.91 arrests per 1000 discharges). In the intervention epoch, the clinical trigger and response tool was activated 106 times over a 1-year period, most commonly due to unexpected new or worsening hypotension. There was no step change in arrest-rate (2.24 arrests/1000 patients, 95%CI -1.82, 6.28, p=0.28) or slope change (-0.02 slope of arrest rate, 95%CI -0.14, 0.11, p=0.79) comparing the pre-intervention and intervention time epochs (see Figure). Cardiac arrests occurring in the pre-intervention epoch were more likely to be deemed ‘potentially preventable’ than those in the intervention epoch (25.6% prior to the intervention vs. 12.3% during the intervention, OR 0.58, 95%CI 0.20, 0.88, p<0.01). Conclusions: A trigger-and-response tool did not reduce the incidence of ICU cardiac arrest. Arrests occurring after introduction of the tool were less likely to be rated as ‘potentially preventable.’

Abstract 18700: Impact of Gender on Clinical Outcomes in Adults With In-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jonah Garry ◽  
Robert Nguyen ◽  
Elinor Schoenfeld ◽  
Sam Parnia ◽  
Jignesh Patel
Keyword(s):  
Cardiac Arrest ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Men And Women ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background: Despite numerous advances in the delivery of resuscitative care, in-hospital cardiac arrest (IHCA) continues to be associated with high morbidity and mortality. We sought to study the impact of gender on return of spontaneous circulation (ROSC) and survival to discharge in patients with IHCA. Methods: The study population included 255 consecutive patients who underwent ACLS-guided resuscitation from January 2012- December2013 for IHCA at an academic tertiary medical center. Baseline demographic, clinical, laboratory, and clinical outcome data were recorded. Outcomes of interest included presence of sustained ROSC (defined as ROSC > 20 minutes) and survival to discharge. Results: Of the 255 patients studied, 96 (37.6%) were women and 159 (62.4%) were men. No difference in age, race, or ethnicity was noted between men and women. Women were shorter (160cm vs 174cm, p<0.001) and had lower weight (78kg vs 89kg, p<0.001), but had a trend towards higher body mass index (31.4 kg/m2 vs 29.4kg/m2, p=0.087). Women had lower rates of peripheral vascular disease (15.6% vs 27.0%, p=0.035) and hyperlipidemia (26.4% vs 41.6%, p=0.017). Rates of other comorbidities, including cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke, diabetes mellitus, chronic kidney disease, and hypertension were similar in men and women. Clinical presentation of IHCA, in particular, the initial rhythm, location of IHCA, duration of cardiopulmonary resuscitation, and laboratory results at the time of IHCA was similar in both men and women. With respect to outcomes, women were noted to have a trend toward lower rates of sustained ROSC (45.8% vs 57.9%, p=0.062) but no difference in survival to discharge (22.9% vs 27.0%, p=0.464). In multivariate analysis, gender was not an independent predictor of sustained ROSC or survival to discharge. Conclusion: Gender is not independently predictive of ROSC or survival to discharge in adults with IHCA.

Abstract 310: Validation of the Cardiac Arrest Hospital Prognosis (CAHP) Score in an American Out-of-hospital Cardiac Arrest Cohort: Results From a Large Single Center Cardiac Arrest Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jason J Grady ◽  
Katie A Atwell ◽  
Tomo Oshimura ◽  
Nima Ghasemzadeh
Keyword(s):  
Cardiac Arrest ◽  
Medical Center ◽  
Cerebral Performance Category ◽  
Serum Lactate ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Single Center ◽  
Neurologic Outcomes ◽  
Increased Risk ◽  
Hospital Cardiac Arrest

Background: The cardiac arrest hospital prognosis (CAHP) score has been shown in French studies to predict neurologic outcomes in patients who suffer an out-of-hospital cardiac arrest (OHCA), but this score has not been studied in an American cohort. We aimed to validate the CAHP score in an independent, single center, large cardiac arrest registry. Methods: Between January 2015 to June 2020 there were 925 patients who suffered OHCA and were transferred to Northeast Georgia Medical Center out of whom 450 patients survived to hospital admission. Cerebral Performance Category (CPC) score was used for assessment of neurologic outcome at discharge ranging from 1-5. The primary endpoint was poor neurologic outcome defined as CPC 3-5. Logistic regression was performed to identify independent predictors of poor neurologic outcome. Results: Included patients were mostly male 57% (256 of 450) with a mean age of 52±15. STEMI was present on 11% (51 of 450) and a shockable rhythm on 35% (150 of 450) of patients. Targeted temperature management (TTM) and a mechanical compression device (MCD) were used in 72% (327 of 450) and 74% (336 of 450) respectively. 76% (344 of 450) had a CPC of 3-5 at discharge. After adjusting for covariates, including gender, BMI, serum lactate level, witnessed arrest status, STEMI on ECG, and use of MCD and TTM, the only independent predictors of a CPC of 3-5 were CAHP score (p<0.001), witnessed cardiac arrest, (p=0.039, OR: 0.45) and STEMI on admission ECG (P=0.001, OR: 0.22). Compared with CAHP< 150, CAHP 150-200 and CAHP>200 were associated with a 12-fold (p<0.00001) and 79-fold (p<0.00001) increased risk of poor neurologic outcome. Area under ROC curve for CAHP score predicting neurologic outcome was 0.92 (95% CI: 0.89-0.94). Conclusion: Here we show, for the first time, in an independent, large American cardiac arrest registry that CAHP score predicts neurologic outcomes in patients with OHCA. Further research is needed to assess how this prognostication tool would help clinicians decide on early vs. delayed invasive strategy in patients with OHCA admitted to hospitals across the U.S.

Abstract 336: Data-driven Classification of Arrest Location for Emergency Department Cardiac Arrests

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Nancy Mikati ◽  
Clifton W Callaway ◽  
Patrick J Coppler ◽  
Jonathan Elmer
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Unsupervised Learning ◽  
Hospital Discharge ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Information ◽  
Large Majority ◽  
Cluster Center ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA), in-hospital cardiac arrest (IHCA), and emergency department (ED) cardiac arrests differ in epidemiology, etiology, and outcomes. Resuscitation research is inconsistent in how ED arrests are classified. We used unsupervised learning to compare ED arrests to non-ED OHCA and to non-ED IHCA. Hypothesis: Clinical features of ED cardiac arrest patients who achieve return of spontaneous circulation (ROSC) are more similar to IHCA than to OHCA. Methods: We performed a retrospective study including all patients resuscitated from cardiac arrest who were treated at a single academic medical center from January 2010 to December 2019. We abstracted clinical information from our prospective registry, including the details of arrest location (ED arrests, OHCA, or IHCA); age; sex; initial arrest rhythm; number of doses of epinephrine, bicarbonate and shocks given during the arrest; duration of arrest; most advanced airway placed intra-arrest; number of rearrests; early post-arrest illness severity (Pittsburgh Cardiac Arrest Category: PCAC); and survival to hospital discharge. We used unsupervised learning (K-prototypes) to identify clusters within the OHCA and IHCA cohorts. We determined the number of subgroups using Scree plots. Finally, we assigned individual ED arrest patients the nearest OHCA or IHCA cluster based on the shortest Gower distance from that patient to the nearest cluster center. Results: We included 2,723 patients: 1,709 (63%) OHCA, 642 (23%) IHCA, and 372 (14%) ED arrests. We identified 3 clusters in the OHCA cohort, and 4 clusters in the IHCA cohort. Of the total ED arrest cases, 292 (78%) most closely resembled an IHCA cluster and 80 (22%) most closely resembled an OHCA cluster. The large majority (64%) of ED arrests that were closest to an IHCA cluster survived to hospital discharge; 50% of this subset were awake post-arrest (PCAC I), and 16% were deeply comatose (PCAC IV). In contrast, only 13% of ED arrests that were closest to an OHCA cluster survived to hospital discharge; 65% of this subset were deeply comatose (PCAC IV) and only 5% were awake post arrest (PCAC I). Conclusion: Among cardiac arrest patients with ROSC, the large majority of ED arrests resemble IHCA more than OHCA.

Abstract 335: The Impact of Early Coronary Angiography on Outcomes in Out-of-hospital Cardiac Arrest: The Singapore Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Shir Lynn Lim ◽  
Yee How Lau ◽  
Mark Chan ◽  
Terrance Chua ◽  
Huay Cheem Tan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Clinical Outcomes ◽  
Obstructive Coronary Artery Disease ◽  
Cerebral Performance Category ◽  
National Database ◽  
Epinephrine Administration ◽  
Neurological Outcomes ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background and Aim: The benefit of early coronary angiography (CAG) and revascularization in resuscitated out-of-hospital cardiac arrest (OHCA) is unclear. We evaluated the association between early CAG and clinical outcomes in these patients. Methods: Data on all resuscitated adult OHCA cases of cardiac etiology between 2011-2015 were extracted from the prospective Singapore Pan-Asian Resuscitation Outcomes Study and linked with data from the national database of cardiac procedures. The 30-day survival and neurological outcomes (good outcome defined as Cerebral Performance Category [CPC] 1 or 2) were compared between patients undergoing early CAG (within 1-calender day) and patients not undergoing early CAG. Inverse probability weighted estimator was used to adjust for propensity to perform early CAG and PCI. Results: Of 976 consecutive patients who survived to admission (mean age 64±13, 73.7% males), 401 (41.1%) patients underwent CAG and obstructive coronary artery disease (CAD) was present in 352 (87.8%), of whom 284 (70.8%) underwent revascularization. Patients who underwent early CAG (n=337[34.5%]) were significantly different compared to those who underwent delayed or no CAG (n=639[65.5%]) (Table 1). Early CAG and PCI patients had improved survival and better neurological outcomes (adjusted odds ratio [AOR] 3.806 [95% CI 1.675 - 8.648] and AOR 3.075 [95% CI 1.119 - 8.451]), compared to those without. The odds of survival decreased with epinephrine administration (AOR 0.357 [95% CI 0.199 - 0.640]), but increased with an initial shockable rhythm (AOR 6.587 [95% CI 3.659 - 11.861]). The rates of bleeding (2% vs 0%, p=0.300) and stroke (1.6% vs 1.9%, p=0.880) were not increased with early intervention. Conclusion: Early CAG and PCI after OHCA were associated with improved clinical outcomes after OHCA without increasing complications. Further studies are required to identify the characteristics of patients who would benefit most from this invasive strategy.

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