Abstract 227: Effect of Optimal Post-Resuscitation Care in Survivors of Out-of Hospital Cardiac Arrest
Objective: This study aimed to determine whether optimal intensive care bundles including reperfusion therapy, hypothermia, coronary artery bypass surgery (CABG), and pacemaker insertion is associated with improved OHCA outcomes in Korea.
Methods: We used a national OHCA cohort database composed of hospital and ambulance data. We included all EMS-treated and survivors from OHCA for the period Jan. to Dec. 2008. We excluded cases with presumed non-cardiac etiology as well as those without available hospital outcome data. The primary outcomes were survival to hospital discharge and good neurologic outcome (cerebral performance category (CPC) 1 to 2). We compared survival to discharge between traditional intensive care group (T-ICU) and optimal intensive care group (O-ICU) group using multivariable logistic regression, adjusting for sex, age, witnessed, prehospital defibrillation, bystander cardiopulmonary resuscitation (CPR), response time, transport time to ED, causes, initial ECG, and metropolitan. We repeated the analysis for good neurologic outcome. Adjusted odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated and Hosmer-Lemeshow goodness of fit (HL) was tested.
Results: Of 18,961 patients with OHCA, we excluded 5,355 (29.3%) with non-cardiac etiology, and 12,307 (64.9%) of non-survival to admission. Finally, 1,299 cases were eligible for this study. Of these, 399 cases were survived to discharge (30.7%). 134 cases (10.3%) of any optimal care were following options (59 (4.5%) for reperfusion therapy, 70 (5.4%) for therapeutic hypothermia, 5 (0.4%) for CABG, and 14 (1.1%) for pacemaker insertion). Survival to discharge rate was higher in O-ICU (56.0%) group versus in T-ICU (26.8%). (p<0.001) Good neurologic outcome was found in O-ICU (54.0%) versus T-ICU (30.4%). In the full multivariable models, adjusted survival to discharge were much higher in O-ICU group compared to T-ICU group: OR 17.4 (95% CI 11.5–26.5) and HL 14.5(p=0.07). Adjusted OR (95% CI) of optimal care for good neurologic outcome was 2,27 (1.30–3.97).
Conclusions: In Korea, optimal intensive care was associated with favorable OHCA survival to discharge and good neurologic outcomes than traditional intensive care.
- © 2010 by American Heart Association, Inc.