European Resuscitation Council Guidelines for Resuscitation 2010 ...

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1360 H.-R. Arntz et al. / Resuscitation 81 (2010) 1353–1363 • Requiring the catheterization laboratory to be ready within 20 min • Having an attending cardiologists always at the hospital • Providing real-time data feedback • Fostering senior management commitment • Encouraging a team-based approach If PPCI cannot be accomplished within an adequate timeframe, independent of the need for emergent transfer, then immediate fibrinolysis should be considered unless there is a contraindication. For those patients with a contraindication to fibrinolysis, PCI should still be pursued despite the delay, rather than not providing reperfusion therapy at all. For those STEMI patients presenting in shock, primary PCI (or coronary artery bypass surgery) is the preferred reperfusion treatment. Fibrinolysis should only be considered if there is a substantial delay to PCI. Triage and inter-facility transfer for primary PCI The risk of death, reinfarction or stroke is reduced if patients with STEMI are transferred promptly from community hospitals to tertiary care facilities for PPCI [82,94,95]. It is less clear whether immediate fibrinolytic therapy (in- or out-of-hospital) or transfer for PPCI is superior for younger patients presenting with anterior infarction and within a short duration of
H.-R. Arntz et al. / Resuscitation 81 (2010) 1353–1363 1361 Anti-arrhythmics There is no evidence to support the use of anti-arrhythmic prophylaxis after ACS. Ventricular fibrillation (VF) accounts for most of the early deaths from ACS; the incidence of VF is highest in the first hours after onset of symptoms. This explains why numerous studies have been performed with the aim of demonstrating the prophylactic effect of antiarrhythmic therapy [107]. The effects of antiarrhythmic drugs (lidocaine, magnesium, disopyramide, mexiletine, verapamil, sotalol, and tocainamide) given prophylactically to patients with ACS have been studied. Prophylaxis with lidocaine reduces the incidence of VF but may increase mortality [108]. Routine treatment with magnesium in patients with AMI does not improve mortality. Arrhythmia prophylaxis using disopyramide, mexiletine, verapamil, or other anti-arrhythmics given within the first hours of an ACS does not improve mortality. Therefore prophylactic anti-arrhythmics are not recommended. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers Oral ACE inhibitors reduce mortality when given to patients with AMI with or without early reperfusion therapy. The beneficial effects are most pronounced in patients presenting with anterior infarction, pulmonary congestion or left ventricular ejection fraction
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