Open the cloted artery with baloon, possibly implant DCB, no stentig or DAPT. 4-8 weeks later repeat coronatgraphy and proceed according to artery condition.

Dražen Bedeković What is the rate that artery is still open or should PCI do in high thrombotic state without any anticoagulation? thnx

As per AHA 2020 guidelines, any out of hospital cardiac arrest ( OHCA) victims , always follow Chain of survival for OHCA , first step is recognition of cardiac arrest and activation of emergency response system - High Quality Chest Compression- Early Defibrillation - Advanced resuscitation - post cardiac arrest care - Recovery, that will differ slightly from in hospital cardiac arrest (IHCA). Such type of victims need first Basic life Support ( BLS) that is mainly based on High quality chest compression , Use of AED and Bag and mask ventilation , If Return of spontaneous circulation (ROSC) achieved then proceed for ACLS that includes use of drugs and establishments of definitive airway

I can respond to query professionally:

1️⃣ Out-of-hospital cardiac arrest due to AMI and traumatic intracranial hemorrhage. How do you intervene?

Response: Management of out-of-hospital cardiac arrest (OHCA) in the presence of acute myocardial infarction (AMI) and traumatic intracranial hemorrhage (TICH) is highly challenging due to the conflicting priorities of treatment.

• Immediate Priorities: Early CPR and defibrillation (if indicated) remain the cornerstone of resuscitation. However, in TICH, aggressive resuscitation may worsen intracranial pressure (ICP).
• Airway and Ventilation: Securing the airway with controlled ventilation is crucial to prevent hypoxia and secondary brain injury. Avoid hyperventilation, as it can reduce cerebral perfusion.
• Circulatory Support: If AMI is suspected, early revascularization is ideal, but anticoagulation (e.g., heparin, dual antiplatelet therapy) must be carefully considered due to the risk of worsening hemorrhage.
• Neuroprotective Measures: Maintain cerebral perfusion pressure while avoiding excessive IV fluids or pressors that might exacerbate intracranial bleeding.
• Hospital Management: A multidisciplinary approach involving emergency medicine, cardiology, and neurosurgery is essential for optimizing outcomes.

Out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI) and traumatic intracranial hemorrhage (TBI-related ICH) presents a complex resuscitation challenge. The approach to intervention must balance the need for cardiopulmonary resuscitation (CPR) while considering the risks of worsening intracranial bleeding.

Initial Approach & Prioritization

Addressing AMI (Suspected STEMI/NSTEMI)

• If return of spontaneous circulation (ROSC) is achieved:12-lead ECG to assess for STEMI. Urgent coronary angiography if AMI is strongly suspected. Consider fibrinolytics cautiously, as they may exacerbate hemorrhage. Hemodynamic support with fluids and vasopressors if needed.

Addressing Traumatic Intracranial Hemorrhage

• If ROSC is achieved:Neurological assessment (pupillary response, Glasgow Coma Scale). Head CT scan to confirm and classify ICH. Blood pressure management (target SBP < 140 mmHg to prevent further bleeding). Neurosurgical consultation for possible intervention (decompression, craniotomy). Avoid anticoagulation/thrombolysis due to risk of worsening hemorrhage.

When to Withhold or Stop Resuscitation?

• Poor prognosis indicators include:No ROSC despite prolonged resuscitation. Fixed and dilated pupils. Severe head injury incompatible with survival. Clinical signs of brain herniation. Asystole with no reversible causes.

Key Takeaways

• Prioritize circulation while considering the impact on brain injury.
• Defibrillate promptly if indicated.
• If ROSC, balance AMI treatment with the risk of worsening ICH.
• Neurosurgical and cardiac interventions should be guided by imaging and clinical status.
• Early decision-making on the futility of resuscitation is crucial in severe traumatic brain injury.

Would you like a more detailed breakdown of any aspect?

Dear Colleagues,

I hope this message finds you well.

I am reaching out to seek your opinions and practices regarding a specific clinical scenario: out-of-hospital cardiac arrest due to acute myocardial infarction (AMI) in patients with concurrent traumatic intracranial hemorrhage.

Unfortunately, I have been unable to find comprehensive information, recommendations, or expert consensus on the management approach for patients presenting with both STEMI and intracranial hemorrhage. While reviewing the 2023 ESC Guidelines for the management of acute coronary syndromes, I noted that the section on "Special Situations" addresses intracranial and massive hemorrhage but does not provide detailed guidance on treatment pathways for these concurrent conditions.

I came across several retrospective studies focusing on head trauma in patients who experienced out-of-hospital cardiac arrest, but they do not clarify the next steps in treatment for this particular situation.

Could you kindly share your practices, opinions, or any relevant literature on this topic? Your insights would be greatly appreciated.

Thank you for your time and assistance.

Always follow BLS and ACLS step wise protocol It will improve the chance of survival of victims

Linee Guida ERC-ILCOR 2021

The question may be a little difficult to understand, but in this case, I would like to ask you about the treatment of STE and hemorrhagic stroke.

Should we do PCI? Is there any data to do PTCA without anticoagulation and DAPT?

Is there ICH where you can do "safe" PCI with SAPT and well controlled ACT?

Whatever underlying cause of cardiac arrest, BLS approach will the same and ACLS approach focuses on treatment of Reversible cause that includes 5 H& T . In this case scenario Victims shifted to cath Lab for Primary PCI and subsequently send to NEURO Ot for further treatment