Abstract 164: Impact of an AHA Guideline-Based, Statewide Postarrest System of Care on Survival from Out-of-Hospital Cardiac Arrest
BACKGROUND: The 2010 American Heart Association (AHA) Guidelines added integrated post-cardiac arrest care as a new 5th link in the classic chain of survival model. In this analysis we: 1) describe utilization of therapeutic hypothermia (TH) and emergent cardiac catheterization in a statewide system of cardiac receiving centers (CRCs) designed to provide integrated, comprehensive post-cardiac arrest care and, 2) measure process and patient outcomes in accordance with the AHA Guidelines.
METHODS: Prospective observational cohort analysis of out-of-hospital-cardiac-arrest (OHCA) victims treated at 34 state health department-recognized CRCs. Data were collected by the centers and entered into a structured database as part of an ongoing statewide OHCA quality improvement program. All CRCs have protocols for TH, prognostication, and organ procurement as well as 24/7 cardiac catheterization (CC) capability. We calculated univariate odds ratios (OR) and 95% confidence intervals (CIs) for various clinical and process parameters and identified which factors were associated with survival and good neurological outcome (CPC score 1 or 2).
FINDINGS: Patient Population: 2821 adult OHCA victims treated at CRCs from 12/14/07 to 12/31/10. Mean age 63.1 years (SD ± 17.0) with 65.8% (1382) males. 705 of the patients (25.0%) had ROSC either en route or in the emergency department. All-rhythm survival was 12.6%. Of those with ROSC, 398 (56.4%) received TH, 263 (37.3%) underwent emergent CC and 179 (26%) received both. Combined therapy with TH and CC was associated with improved survival compared to single therapy or neither treatment [both: 55.9% (100/179) versus single/neither: 27.2% (143/526), p<0.01; non-adjusted OR 3.4, CI 2.4-4.8]. Patients who received a combination of TH and CC were also more likely to have better neurological outcomes (CPC 1 or 2) at hospital discharge compared to those with only one/neither treatment [40.8% (73/179) versus 16.5% (87/526) respectively, p<0.01; non-adjusted OR 3.5, CI 2.4-5.1].
CONCLUSION: Post-arrest treatment with both therapeutic hypothermia and emergent cardiac catheterization following out-of-hospital cardiac arrest was associated with better outcomes in a statewide system of cardiac receiving centers.
- © 2011 by American Heart Association, Inc.