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Cardiac arrest
What's new
The updated American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for acute coronary syndromes (ACS) provide recommendations for the management of resuscitated patients after cardiac arrest. Primary PCI is recommended in the presence of evidence of STEMI for noncomatose patients and comatose patients with favorable prognostic features. It is also suggested for selected comatose patients with unfavorable prognostic features. Immediate angiography is not recommended for comatose, electrically and hemodynamically stable patients without evidence of STEMI. .
Background
Overview
Definition
Cardiac arrest is defined as the functional loss of mechanical cardiac activity, leading to cessation of systemic circulation.
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Pathophysiology
The most common cause of out-of-hospital cardiac arrest is ischemic heart disease, with up to 70% patients with out-of-hospital cardiac arrest having significant coronary artery disease on coronary angiography. In patients with in-hospital cardiac arrest, arrhythmias and myocardial ischemia represent the most common causes. Other causes of cardiac arrest include non-ischemic heart disease, as well as non-cardiac diseases (shock of any etiology, hypoxia, hypoglycemia, hypothermia, electrolyte and acid-base disturbances, drug overdose).
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Epidemiology
In the US, the incidence of cardiac arrest is estimated at 55 cases per 100,000 person-years. The incidence of in-hospital cardiac arrest is estimated at 1-6 cases per 1,000 hospital admissions.
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Disease course
Patients who achieve ROSC after cardiac arrest have a high mortality rate, owing to the development of post-cardiac arrest syndrome, which is characterized by multi-organ dysfunction, including post-cardiac arrest brain injury and post-cardiac arrest myocardial dysfunction.
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Prognosis and risk of recurrence
In patients with out-of-hospital cardiac arrest, 30-day survival is estimated at 5.8% in patients in whom CPR is not performed, and 13.5-13.8% in patients in whom CPR is performed. In patients with in-hospital cardiac arrest, 30-day survival is estimated at 28.3%.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of cardiac arrest are prepared by our editorial team based on guidelines from the Society for Cardiovascular Angiography and Interventions (SCAI/NAEMSP/AHA/ACC/ACEP 2025), the Society of Critical Care Medicine (SCCM 2025,2016), the Agency for Healthcare Research and Quality (AHRQ 2024), the American College of Emergency Physicians (ACEP 2024), the American Heart Association ...
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