Hi, my name is Dave Seder,
I'm a Critical Care Specialist
at Maine Medical Center
in Tufts University in Portland, Maine.
And I'm going to be speaking to you today
about the "Post-Resuscitation Syndrome
After Cardiac Arrest".
So, I'm gonna move on now,
after talking about protecting the brain,
to talking about protecting the heart.
So I'm gonna go back to this diagram
of what patients die
from after a cardiac arrest.
And when I used to look at this slide,
I saw the big blue slice
that's hypoxic-ischemic encephalopathy,
and I thought that it was important
to put all of our eggs in that basket
and work primarily on protecting the brain.
But now I know that that's wrong!
And that we really have to focus
on all of these different categories
and improve the treatment
related to the brain,
the heart, and the rest of the organs
as best we can, to gain
the best results in our patients.
So these 23% or 26% of patients,
dying from a circulatory etiology deaths,
need to be directly addressed.
So we know from several studies
that acute myocardial infarction
or heart attacks
are very common in patients
who are resuscitated from a cardiac arrest.
And that's primarily true
in out-of-hospital cardiac arrest,
but there is not an insignificant number
of acute myocardial infarctions in patients
who also undergo
an in-hospital cardiac arrest.
And if you look at the out-of-hospital
cardiac arrest population,
what turns out to be true,
is that about half of the patients
are having myocardial infarction;
and somewhere between 25% and 35% overall
have the need for urgent
So the data on the right
are from a large group of
primary cardiac arrest centers
in the United States,
between 2003 and 2012.
And what the investigators
in the United States found
was that about 80% of patients
who have an ST elevation MI,
who have clear evidence on their EKG
when they come into the hospital
having an acute heart attack,
80% of those patients, when they undergo
urgent coronary angiography,
will have a culprit lesion
that needs to be revascularized.
In patients who have a presumed
cardiac cause of the arrest
but do not have an ST elevation MI
or obvious evidence of a transmural
ongoing myocardial infarction
on their electrocardiogram,
33% of those patients
still have acute MI
and require revascularization.