Abstract 59: Advanced Treatments for Shock-Resistant Ventricular Fibrillation at Critical Care Medical Centers: the Utstein Osaka Project
Background: Outcomes of shock-resistant ventricular fibrillation (VF) are still dismal. Although it is reported that transportation of the out-of-hospital cardiac arrest (OHCA) victims to critical care medical centers (CCMCs) would improve their outcomes, the actual treatments performed in CCMCs is not known.
Objectives: We aimed to describe the actual treatments provided to shock-resistant VF cases at CCMCs.
Methods: We enrolled all patients aged 18 years or more who suffered OHCA of presumed cardiac etiology, were witnessed by bystanders, treated by emergency medical service (EMS) personnel, and had VF as initial rhythm in Osaka Prefecture, Japan from January, 2008 through December, 2008. Data on treatments after transportation to CCMCs were collected by a questionnaire survey from 11 centers and were combined the EMS's Utstein-style database.
Results: During the study period, there were 333 witnessed VF cardiac arrests of presumed cardiac etiology and 320 of them received defibrillation before arriving at hospital. Eighty-five (26.6%) were shock-resistant and 43 of them were transported to CCMCs. Questionnaire survey for the treatments in CCMCs were completed for 29 cases. Coronary angiography (CAG) was performed during cardiac arrest or soon after return of spontaneous circulation in 18 cases (62.1%) and 10 of them were treated with percutaneous coronary interventions (PCI). The extracorporeal life support was introduced for 12 cases (41.4%), nifekalant hydrochloride was administrated to 13 cases (44.8%), and therapeutic hypothermia was induced in 14 cases (48.3%). The proportion of CAG during resuscitation was different by institutions ranging from 100% (4/4) to 0% (0/4). So was the use of extracorporeal life support from 100% (6/6) to 0% (0/4), nifekalant hydrochloride from 75% (3/4) to 0% (0/4), and therapeutic hypothermia from 100% (4/4) to 0% (0/6).
Conclusion: Even in the CCMCs, treatments for shock-resistant VF were quit different by CCMCs. Further efforts to establish treatment strategy by evaluating the effectiveness of in-hospital advanced life support measures for OHCA patients should be needed.
- © 2010 by American Heart Association, Inc.