Abstract P33: Impact of Rapid Cooling, a Multidisciplinary Post Resuscitation Strategy, and Regionalization of Care Compared to Hypothermia Alone on Outcomes After Out of Hospital Cardiac Arrest
Background: Hypothermia (H) improves survival from VF OOH-CA. Addition of a standardized multidisciplinary post resuscitation strategy (SMPRS), faster time to target temperature, and higher patient (pt) volume are associated with improved outcome in CA.
Hypothesis: Addition of a SMPRS and implementation of a regional post resuscitation (PR) center will improve outcome after VF OOH-CA more than H alone.
Methods: H by external cooling was added to routine, non-standardized PR care in 2003 for adult OOH-CA pts irrespective of presenting rhythm. An aggressive SMPRS (initiation of cold IV saline by EMS during resuscitation, rapid hospital evaluation with continued cooling using an intravascular device, and a standardized pathway of neurologic, hemodynamic, ventilatory, and metabolic management) was implemented in 2008. Since 2008, our Advanced Resuscitation, Cooling Therapeutics, and Intensive Care (ARCTIC) Center receives pts from 3 EMS systems, 1 air transport system, and 2 referring hospitals. We evaluated time to target 34 °C, survival to discharge and CPC in 115 consecutive OOH-CA pts undergoing H alone compared to H+SMPRS+regionalization of care from 3/1/04 –5/1/09.
Results: Mean monthly pt volume was 1.0 [0.4,1.6] from 2004 – 07 and increased to 4.6 [0.8,8.2] in 2008 – 09. Age, % witnessed, bystander CPR/AED were not different with H alone vs. ARCTIC. Results in table⇓.
Conclusion: A single high volume regional referral center focusing on early initiation of H, rapid time to target temperature, and standardized approach to PR management results in a strong trend for improved survival and neurologic outcomes for OOH-CA patients with VF compared to H alone.