Abstract 44: Cardiac Catheterization After In-hospital Cardiac Arrest: Guidelines Needed
Background: The benefit of immediate cardiac catheterization after in-hospital cardiac arrest is uncertain as electrocardiographic and clinical criteria may be unreliable in this population. We sought to evaluate rates of cardiac catheterization after in-hospital ventricular fibrillation (VF) cardiac arrest and the potential association of cardiac catheterization with survival.
Methods: Using a single hospital billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or ventricular fibrillation (427.41). Discharge summaries were then reviewed to identify arrests that occurred in-hospital with an initial rhythm of VF. Rates of catheterization were determined by identifying cardiac catheterization charges on the day of or day after arrest. All cardiac catheterization reports were reviewed. Unadjusted analysis was preformed to look for factors that may have contributed to survival to hospital discharge. A logistic regression was performed to further evaluate possible interactions.
Results: There were 110 patients with return of circulation after VF in-hospital arrest included in the analysis. Cardiac catheterization was performed immediately or within one day of arrest in 27% (30/110) of patients and 57% (17/30) received angioplasty. Of those who received cardiac catheterization the indication for the procedure was ST elevation myocardial infarction (STEMI) in 12% (13/110) of cases. Using an unadjusted model, patients who received cardiac catheterization were more likely to survive (80% vs. 54%, p<.01). Controlling for cardiac catheterization, age, gender, and race using logistic regression, this relationship persisted with patients undergoing cardiac catheterization having a 3.8 increased odds of survival (OR 3.8, 95% CI 1.35–10.90, p< .01).
Conclusion: In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI. Cardiac catheterization was associated with better survival although this study is limited in its ability to draw inference or causality. Future recommendations need to be established to guide clinicians on which in-hospital cardiac arrest patients might benefit from immediate cardiac catheterization.