***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background — Despite intensive efforts over many years , the United States has made limited progress in improving rates of survival from out-of-hospital cardiac arrest . Recently , national organizations , such as the American Heart Association , have focused on promoting byst and er cardiopulmonary resuscitation , use of automated external defibrillators , and other performance improvement efforts . Methods and Results — Using the Cardiac Arrest Registry to Enhance Survival ( CARES ) , a prospect i ve clinical registry , we identified 70 027 U.S. patients who experienced an out-of-hospital cardiac arrest between October 2005 and December 2012 . Using multilevel Poisson regression , we examined temporal trends in risk-adjusted survival . After adjusting for patient and cardiac arrest characteristics , risk-adjusted rates of out-of-hospital cardiac arrest survival increased from 5.7 % in the reference period of 2005 to 2006 to 7.2 % in 2008 ( adjusted risk ratio , 1.27 ; 95 % confidence interval , 1.12–1.43 ; P<0.001 ) . Survival improved more modestly to 8.3 % in 2012 ( adjusted risk ratio , 1.47 ; 95 % confidence interval , 1.26–1.70 ; P<0.001 ) . This improvement in survival occurred in both shockable and nonshockable arrest rhythms ( P for interaction=0.22 ) and was also accompanied by better neurological outcomes among survivors ( P for trend=0.01 ) . Improved survival was attributable to both higher rates of prehospital survival , where risk-adjusted rates increased from 14.3 % in 2005 to 2006 to 20.8 % in 2012 ( P for trend<0.001 ) , and in-hospital survival ( P for trend=0.015 ) . Rates of byst and er cardiopulmonary resuscitation and automated external defibrillator use modestly increased during the study period and partly accounted for prehospital survival trends . Conclusions — Data drawn from a large subset of U.S communities suggest that rates of survival from out-of-hospital cardiac arrest have improved among sites participating in a performance improvement registry BACKGROUND Timing of coronary angiography ( CAG ) is still controversial in the out-of-hospital cardiac arrest survivors who present without ST-segment elevation . METHODS AND RESULTS We analysed a prospect i ve registry of 158 comatose survivors of out-of-hospital cardiac arrest . For further analysis , we included 99 patients without ST-segment elevation on the initial electrocardiogram . All patients underwent temperature management . Urgent CAG ( < 2h from admission ) was performed in 25 % of the patients . A definite cause of the cardiac arrest could be identified during the index hospitalization in 82 patients : 36 had a non-ST-segment elevation acute coronary syndrome ( NSTE-ACS ) and 46 had a non-ACS diagnosis . Eighty-seven patients ( 88 % ) survived the index hospitalization and 65 ( 66 % ) were alive at six months . A favourable neurological status ( cerebral performance category ≤ 2 ) was observed in 56 % of the patients at discharge and in 56 % after six months of follow-up . Neither the survival nor the neurological outcome differed between the patients in whom the CAG was performed urgently upon the admission and the patients in whom the CAG was initially not performed , regardless of the aetiology of the cardiac arrest . On the other h and , performing an urgent CAG  was safe and it did not prolong the average time to achieve an effective hypothermia . CONCLUSIONS Performing an urgent CAG in comatose cardiac arrest survivors without ST-segment elevation was not associated with better clinical and neurological outcome as compared to the initially conservative approach Purpose To investigate whether early coronary angiography ( CAG ) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation . Methods The target temperature management after out-of-hospital cardiac arrest ( TTM ) trial showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 ° C . In this post hoc analysis , 544 patients where the admission electrocardiogram did not show acute ST elevation were included .  Early CAG was defined as being performed on admission or within the first 6 h after arrest . Primary outcome was mortality at the end of trial . A Cox proportional hazard model was created to estimate hazard of death , adjusting for covariates . In addition , a propensity score matched analysis was performed . Results A total of 252 patients ( 46 % ) received early CAG , whereas 292 ( 54 % ) did not . At the end of the trial , 122 of 252 patients who received an early CAG ( 48 % ) and 159 of 292 patients who did not ( 54 % ) had died . The adjusted hazard ratio for death was 1.03 in the group that received an early CAG ; 95 % CI 0.80–1.32 , p = 0.82 . In the propensity score analysis early CAG was not significantly associated with survival . Conclusions In this post hoc observational study of a large r and omized trial , early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved survival . A r and omized trial is warranted to guide clinical practice AIM OF THE STUDY To question the beneficial effects of the recommended early percutaneous coronary intervention ( PCI ) after out-of-hospital cardiac arrest on 30-day survival with favourable neurological outcome . METHODS Prospect ively collected data of 1277 out of hospital cardiac arrest patients between 2005 and 2010 from a registry at a tertiary care university hospital were used for a cohort study . RESULTS In 494 ( 39 % ) arrest patients ST-segment elevation was identified in 249 ( 19 % ) . Within 12h after restoration of spontaneous circulation catheter laboratory investigations were initiated in 197 ( 79 % ) and PCI in 183 ( 93 % ) ( 78 % got PCI in less than 180 min ) . Adjustment for a cumulative time without chest compressions < 2 min , initial shockable rhythm , cardiac arrest witnessed by healthcare professionals , and a higher core temperature at time of hospitalization reduced the effect of PCI on favourable neurological outcome at 30 days ( OR 1.40 ; 95 % CI , 0.53 - 3.7 ) compared to the univariate analysis ( OR 2.52 ; 95 % CI , 1.42 - 4.48 ) . CONCLUSION This cohort study failed to demonstrate the beneficial effects of PCI as part of post-resuscitation care on 30-day survival with a favourable neurological outcome Background : Aggressive post-resuscitation care , in particular combining mild therapeutic hypothermia ( MTH ) with early coronary angiography ( CAG ) and percutaneous coronary intervention ( PCI ) , may improve prognosis after out-of-hospital cardiac arrest ( OHCA ) . Objectives : The study aims to assess the value of immediate CAG or PCI in comatose survivors after OHCA treated with MTH and their association with outcomes . Methods : Observational , prospect i ve analysis of all comatose , resuscitated patients treated with MTH at a tertiary centre and undergoing CAG or PCI ≤6 hours after OHCA , or non-invasively managed . Primary outcomes were 30-day and 1-year survival . Results : From March 2004–December 2012 , 141 ( 51 % ) out of 278 comatose patients after cardiac OHCA were treated with MTH ( median age : 64.5 ( interquartile range 55–73 ) years , males : 67 % , first shockable rhythm : 70 % , witnessed OHCA : 94 % , interval OHCA-resuscitation≤20 min : 81 % ) . Ninety-seven patients ( 69 % ) underwent early CAG , and 45 ( 32 % ) of them PCI . Patients undergoing CAG or PCI had a more favourable risk profile than subjects non-invasively managed . PCI treated patients had more bleedings , but no stent thrombosis occurred . Thirty-day and one-year unadjusted total mortality rates were 50 % and 72 % for non-invasively managed patients , 26 % and 38.7 % for patients su bmi tted only to CAG and 32 % and 36.6 % for patients treated with PCI ( p=0.0435 for early death , and p<0.0001 for one-year mortality , respectively ) . However , a propensity-matched score analysis did not confirm the survival advantage of invasive management ( p=0.093 ) . At multivariable analysis , clinical and OHCA-related variables as well as CAG , but not PCI , were associated with outcomes . Conclusions : Comatose patients cooled after OHCA and su bmi tted to emergency CAG or PCI are a favourable outcome population that receives optimal post-arrest care AIM OF STUDY Favourable hospital survival increased from 26 % to 56 % in the implementation phase of a new st and ard operating procedure ( SOP ) for treatment after out-of hospital cardiac arrest ( OHCA ) in 2003 . We now evaluate protocol adherence and survival rates after five years with this established SOP . METHODS This observational study is based on prospect ively collected registry data from all OHCA patients with cardiac aetiology admitted with spontaneous circulation to Ulleval Hospital between September 2003 and January 2009 . Three patient categories are described based on early assessment in the emergency department : conscious , comatose , and comatose patients receiving only palliative care , with main focus on comatose patients receiving active treatment . RESULTS Of 248 patients , 22 % were consciousness on admission , 70 % were comatose and received active treatment , while 8 % received only palliative care .  Favourable survival from admittance to discharge remained at 56 % throughout the study period . Among actively treated patients 83 % received  emergency coronary angiography  and 48 % underwent subsequent percutaneous coronary intervention .  In this cohort 63 % had an acute myocardial infa rct ion , ten of whom did not receive emergency  coronary angiography .  Among actively treated comatose patients , 6 % survived with unfavourable neurology , while 51 % of the deaths followed treatment withdrawal after prognostication of severe brain injury . CONCLUSION The previously reported doubling in survival rate remained throughout a five-year study period . Establishing reliable indication for emergency coronary angiography and interventions and validating prognostication rules in the hypothermia era are important challenges for future studies AIM To determine if early cardiac catheterization ( CC ) is associated with improved survival in comatose patients who are resuscitated after cardiac arrest when electrocardiographic evidence of ST-elevation myocardial infa rct ion ( STEMI ) is absent . METHODS We conducted a retrospective observational study of a prospect i ve cohort of 754 consecutive comatose patients treated with therapeutic hypothermia ( TH ) following cardiac arrest . RESULTS A total of 269 ( 35.7 % ) patients had cardiac arrest due to a ventricular arrhythmia without STEMI and were treated with TH . Of these , 122 ( 45.4 % ) received CC while comatose ( early CC ) . Acute coronary occlusion was discovered in 26.6 % of patients treated with early CC compared to 29.3 % of patients treated with late CC ( p=0.381 ) . Patients treated with early CC were more likely to survive to hospital discharge compared to those not treated with CC ( 65.6 % vs. 48.6 % ; p=0.017 ) . In a multivariate regression model that included study site , age , byst and er CPR , shock on admission , comorbid medical conditions , witnessed arrest , and time to return of spontaneous circulation , early CC was independently associated with a significant reduction in the risk of death ( OR 0.35 , 95 % CI 0.18 - 0.70 , p=0.003 ) . CONCLUSIONS In comatose survivors of cardiac arrest without STEMI who are treated with TH , early CC is associated with significantly decreased mortality . The incidence of acute coronary occlusion is high , even when STEMI is not present on the postresuscitation electrocardiogram Background —Whether to perform or not an immediate percutaneous coronary intervention ( PCI ) after out-of-hospital cardiac arrest is still debated . We aim ed to evaluate the impact of PCI on short- and long-term survival in out-of-hospital cardiac arrest patients admitted after successful resuscitation . Methods and Results —Between 2000 and 2013 , all nontrauma out-of-hospital cardiac arrest patients admitted in a Parisian cardiac arrest center after return of spontaneous circulation were prospect ively included . The association between immediate PCI and short- and long-term mortality was analyzed using logistic regression and Cox multivariate analysis , respectively . Propensity score-matching method was used to assess the influence of PCI on short- and long-term survival . During the study period , 1722 patients ( 7 
    Output:
    
Conclusion Among patients resuscitated from OHCA , early coronary angiography is associated with increased survival to discharge and favourable neurological outcome