Cooling should begin before or at the time of cardiac catheterization. Approximately 5% of patients with STEMI who survive to reach the hospital will experience a cardiac arrest during Reports from high-volume PCI centers indicate that 4% to 11% of patients with STEMI who are treated with PCI are brought to cardiac catheterization after being resuscitated from out-of-hospital cardiac arrest.77,197,198 However, the percentage of out-of-hospital cardiac arrest vic- tims whose event is triggered by an acute coronary occlusion is less clear. The majority of out-of-hospital cardiac arrest patients who cannot be resuscitated have significant coronary Coronary atherosclerosis is also present in the majority of cardiac arrest victims who survive and undergo Because of the high prevalence of acute coronary artery occlusions in out-of-hospital cardiac arrest patients who are resuscitated successfully, especially those whose initial rhythm is VF in the setting of STEMI, the AHA 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care201 recommend emer- gency coronary angiography with prompt opening of the infarct artery. Out-of-hospital cardiac arrest victims with ini- tial VF who survive to hospital admission have a rate of sur- vival to hospital discharge of 60% after early PCI. The AHA issued a policy statement calling for communi- ties to establish regional systems of care for out-of-hospital The statement defines 2 different levels of cardiac resuscitation centers and lists the essential elements of such a system. PCI-capable hospitals become ideal can- didates to serve as Level I cardiac resuscitation centers that can offer a wide range of services, including timely PCI when indicated, a goal-directed care bundle,202,203 therapeutic frequent or continuous electroencephalo- graphic monitoring, a multidisciplinary team approach, and neuropsychiatric evaluation for survivors. 