Hot off the press is the COACT trial randomizing patients to immediate vs. delayed cardiac catheterization after cardiac arrest. I had this on my list to do a ‘cast on, but EMCrit Team Member Felipe Teran beat me to it. He interviews past show guest and the lead author of the editorial on the paper, Ben Abella. The trial only included patients with an initial shockable rhythm and they were still unconscious. STEMIs went right to the lab.
COACT Trial
- Actual Paper1
- Editorial2
This comes right at the heels of the AHA statement by Yannopoulos et al. recommending a more aggressive stance on immediate cath.3
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Update
Tomahawk Trial also shows no benefit for post-arrest cath unless STEMI is present. My belief is this should be Non-OMI rather than Non-STEMI, but it is yet more reassurance that we are safe not rushing to cath. (10.1056/NEJMoa2101909)
Now on to the Podcast…
Additional New Information
More on EMCrit
- Who to Cath Post-Arrest?(Opens in a new browser tab)
- Podcast 114 – Post-Arrest Care in 2013 with Stephen Bernard – Part II(Opens in a new browser tab)
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Does this reflect, to some degree, the variation in practice between the Netherlands and the US. I.e. in the studied patients there were few “Intervenable lesions”. We know that if you take 10 cardiologists, show them a cath you will get 20 different opinions on whether a lesion is “intervenable”. At this point, I think the validity of this study may be supported by this issue. Will be interested to see if the next few RCTs show the same outcomes. Then… We will be very interested in the behavior of the AHA writing group. Will they bend to RCT data?… Read more »
Can I only serve to help bridge the internet gaps between great thinkers. Check out Dr Smith’s EKG blog for his example of COACT gone wrong. https://hqmeded-ecg.blogspot.com/2020/11/a-woman-in-her-60s-with-vfib-arrest-and.html In short, because STEMI vs NSTEMI is a flawed paradox, other EKG markers of OMI may be ignored. To quote Dr Smith Blog: This study had a fatal flaw: they did not keep track of all the “Non-STEMI patients” who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very… Read more »