(DISCO-study: DIrect or Subacute Coronary angiography for Out-of-hospital cardiac arrest
The main DISCO-study will continue where the pilot phase left of. DISCO is a study on patients with return of spontaneous circulation (ROSC) after cardiac arrest. Patients without ST-elevation on first ECG after ROSC will be randomized to either acute coronary angiography with eventual percutaneous coronary intervention or standard intensive care without acute coronary angiography. Since coronary angiography in the study should be possible to perform within 120 minutes after inclusion and randomisation.
The ambulance staff has an important role in making study inclusion possible and thus increasing our knowledge regarding improvement of care for these critically ill patients.
Patients with ST-elevation after ROSC have also be included in the pilot phase. However, the STEMI-patients have not been randomized but treated according to current guidelines (normally acute coronary angiography) and where followed in the pilot phase as a control group.
Randomization should take place as early as possible, and may be performed already prehospital. This implies that prehospital personnel, as soon as possible with regard to patient safety after ROSC, should send a 12-lead ECG to Cardiac ICU. The cardiologist on call will fill in screening form and eventually make the randomization/inclusion. If ECG is not sent prehospital or if the cardiologist has not been able to make the inclusion decision before the patients arrival to the hospital the inclusion/randomization is made in the Emergency room by the on call cardiologist.
-Witnessed out-of-hospital cardiac arrest with ROSC (return of spontaneous circulation)
-Coronary angiography possible to be performed (started) within 120 minutes after inclusion and randomization
-Patient age < 18 years
-Clear signs of non cardiac cause for cardiac arrest (e.g. trauma, hypovolemic shock, asphyxia, drug over dose or cerebrovascular incident)
-Patients with terminal disease with expected survival less than one year
-ST elevation on initial ECG
-Patient awake RLS 1-3 or GCS >8