Abstract 169: Neurological and Cardiovascular Outcomes After Cardiac Arrest at 6 Regional Interventional Cardiology Centers in the United States, 2007-2011
Background: We characterized adverse events and outcomes among cardiac arrest (CA) survivors treated between 2007-2011 at six regional interventional cardiology (PCI) centers in the United States.
Methods: Demographics, clinical features, adverse events, cardiovascular outcomes, and 6-month neurological outcomes of 663 sequential patients were retrospectively and prospectively entered into a secure, web-based registry (INTCAR). The overall survival of patients with VT/VF and PEA/asystole was calculated, and an expected “survival index” for each center developed
Results: Patients were characterized as mean 61.3 (+14.9) years old, 69.2% male, 58.8% initial VT/VF, 23.5 (+16.3) minutes “downtime”. On admission, 31.1% had shock, 26% STEMI, 38.6% underwent urgent coronary angiography, and 20.2% urgent PCI. Moderate or severe left ventricular dysfunction was present in 63% patients on presentation and 49.5% at hospital discharge (P<0.001). Frequent adverse events were shock requiring vasopressors (81.6%) or balloon counterpulsation (9.5%), shivering requiring neuromuscular blockade (74.8%), hyperglycemia (66.1%), electrolyte disturbances (62.9%), arrhythmias (37.9%), seizures (26.5%), pneumonia (25%), and bleeding (9.5%). Of 370/663 (55.8%) patients that died during hospitalization, at a median of 4.7 (+3.9) days, discontinuation of life support occurred in 52%, and the cause of death was reported as neurological in 64.6% or cardiovascular in 35.4%. Good neurological outcome at 6 months was as follows: Overall (all rhythms) 38.2%, of VT/VF 53.2%, of PEA/Asystole 17.9 %, of those with shock on admission 38.1%. When corrected for case mix (%VT/VF vs. PEA/asystole), the ratio of actual to anticipated survival varied among centers from 0.87 to 1.43. Among patients surviving to discharge, 54.2% had reportedly normal left ventricular (LV) function, 29.2% moderate LV dysfunction, and 16.6% severe LV dysfunction. Of 282 patients surviving to 6-month follow-up, 89.7% were categorized as CPC1-2 and 10.3% as CPC 3-4.
Conclusions: Across a geographically diverse group of PCI centers in the United States routinely employing therapeutic hypothermia for neuroprotection, cardiac arrest outcomes at centers employing TH and PCI were favorable.
- © 2011 by American Heart Association, Inc.