Related Experiment Video
Updated: Jun 28, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiac catheterization is underutilized after in-hospital cardiac arrest
Raina M Merchant1, Benjamin S Abella, Monica Khan
1The Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, United States. raina.merchant@uphs.upenn.edu
Insights
Immediate cardiac catheterization after in-hospital ventricular fibrillation (VF) arrest in survivors, even without ST elevation myocardial infarction (STEMI), was associated with improved survival. Further research is needed to guide optimal patient selection for this intervention.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care Medicine
Background:
- Uncertainty exists regarding indications for immediate cardiac catheterization in cardiac arrest survivors without ST-elevation myocardial infarction (STEMI).
- Electrocardiographic and clinical criteria for guiding catheterization in these patients can be challenging to interpret.
- This study evaluates early catheterization rates and survival associations after in-hospital ventricular fibrillation (VF) arrest.
Purpose of the Study:
- To assess the frequency of early cardiac catheterization in survivors of in-hospital VF arrest.
- To determine the association between early cardiac catheterization and survival rates in this patient population.
- To explore the indications for cardiac catheterization in VF arrest survivors.
Main Methods:
- Retrospective analysis of a billing database using ICD-9 codes for cardiac arrest (427.5) and VF (427.41).
- Discharge summaries were reviewed to confirm in-hospital VF arrests.
- Rates of catheterization were determined by billing charges; logistic regression was used for adjusted analyses.
Main Results:
- 110 in-hospital VF arrest survivors were analyzed; 27% underwent cardiac catheterization within 1 day of arrest.
- Of those catheterized, 57% received percutaneous coronary intervention (PCI).
- Indications for catheterization were STEMI or new left bundle branch block (LBBB) in 43%; 57% received angiography without these specific indications.
- Cardiac catheterization was associated with significantly higher survival rates (80% vs. 54%, p<.05).
Conclusions:
- Over half of cardiac catheterizations in VF arrest survivors were performed for indications other than STEMI or new LBBB.
- Cardiac catheterization demonstrated a positive association with improved survival in this cohort.
- Development of clear recommendations is needed to guide clinicians on selecting arrest survivors who may benefit from immediate catheterization.
Background:
Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival.
Methods:
Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using Chi-square, and adjusted analyses were performed using logistic regression.
Results:
One hundred and ten in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within 1 day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, p<.05).
Conclusion:
In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.
More Related Videos
07:02Utilizing the Modified T-Maze to Assess Functional Memory Outcomes After Cardiac Arrest
Published on: January 5, 2018
08:19Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs
Published on: July 12, 2022
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:24Cardiac Catheterization III: Left Heart Catheterization
01:26Cardiac Catheterization IV: Nursing Management
01:21Cardiac Catheterization II: Right Heart Catheterization
01:23Cardiopulmonary Resuscitation III: AED Use
01:21Cardiopulmonary Resuscitation I: Adult