Out of hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality worldwide. Clinical decision making is extremely difficult in this understudied patient population with high prevalence of neurological injury and inexorable shock states. As such, there are uncertain benefits from therapies available in the cardiac catheterization laboratory. Fear of futility and public reporting often affects decision making and can result in risk aversion. This review focuses on invasive management in OHCA care, with particular focus on coronary angiography, coronary revascularization, and mechanical support. Guidelines recommend emergency coronary angiography in patients with ST-segment elevations on ECG after OHCA, while the role of coronary angiography in patients without ST-segment elevations is less clear. Similar uncertainty remains in the appropriate revascularization strategy in these patients. As in other areas of cardiology, there is a growing interest in the role of mechanical circulatory support after OHCA, though the available literature shows mixed results. The many uncertainties associated with treating the patient with OHCA highlight the importance of clinical decision support tools and treatment algorithms in the care of this population. This review focuses on invasive management in OHCA care, with particular focus on coronary angiography, coronary revascularization, and mechanical support.

中文翻译：

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医院外心脏骤停的侵入性管理。

医院外心脏骤停（OHCA）是全球发病率和死亡率的主要原因。在神经病患病率高且无休克的休克状态下，对于这一研究不足的患者人群，临床决策极为困难。这样，在心脏导管实验室中可获得的疗法带来的不确定的收益。担心徒劳无功和公开报道通常会影响决策制定，并可能导致规避风险。这篇综述的重点是OHCA护理中的侵入性管理，尤其是冠状动脉造影，冠脉血运重建和机械支持。指南建议，OHCA后心电图ST段抬高的患者应进行紧急冠状动脉造影，而ST段抬高无ST段抬高的患者的冠状动脉造影作用尚不清楚。这些患者在适当的血运重建策略中仍存在类似的不确定性。与其他心脏病学一样，OHCA后机械循环支持的作用越来越引起人们的关注，尽管现有文献表明结果不一。与OHCA治疗患者相关的许多不确定性凸显了临床决策支持工具和治疗算法在该人群护理中的重要性。这篇综述的重点是OHCA护理中的侵入性管理，尤其是冠状动脉造影，冠脉血运重建和机械支持。与OHCA治疗患者相关的许多不确定性凸显了临床决策支持工具和治疗算法在该人群护理中的重要性。这篇综述的重点是OHCA护理中的侵入性管理，尤其是冠状动脉造影，冠脉血运重建和机械支持。与OHCA治疗患者相关的许多不确定性凸显了临床决策支持工具和治疗算法在该人群护理中的重要性。这篇综述的重点是OHCA护理中的侵入性管理，尤其是冠状动脉造影，冠脉血运重建和机械支持。