Abstract 24: Postresuscitation Care Practices Following Cardiac Arrest at 6 Regional Interventional Cardiology Centers in the United States, 2007-2011
Background: We characterized post-resuscitation care practices in cardiac arrest (CA) survivors at six regional PCI centers in the United States.
Methods: Demographics, hospital course, and treatments of 663 cardiac arrest survivors were retrospectively and prospectively entered into a secure, web-based registry (INTCAR). Interhospital variability was evaluated, and group practices compared to AHA guidelines.
Results: Mean age was 61 (+14.9) years, 69.2% male, 58.8% VT/VF, 23.5 (+16.3) minutes from arrest to return of spontaneous circulation (ROSC), 31.1% had shock and 26% STEMI at admission. 50% patients were received in transfer, at estimated mean distance of 37.2 miles and 72.4 (+26.6) minutes from initial ED presentation to destination. Overall, 38.6% underwent urgent cardiac catheterization and 20.2% urgent PCI. 98% patients received therapeutic hypothermia (TH), using a surface cooling device (98.6%), cold fluids (18%), ice packs (29.7%), or an intravascular cooling device (1.2%). 74.9% patients received neuromuscular blockade during hypothermia. Mean time from ROSC to initiation of TH was 178 (+142) minutes, and ROSC to target temperature 375 (+197) minutes. The highest volume center had shorter time from ROSC to onset of therapeutic hypothermia (97+87 vs 178+142 minutes, P<0.001) and target temperature (314+346 vs. 375+197 minutes, P<0.001) than the group mean. 15.5% patients underwent MRI, 41.7% head CT, 33.6% continuous EEG monitoring, 16.5% IABP, and 9.5% AICD placement. Urgent coronary angiography at admission varied from 15-58%; this and other differences in treatment were incompletely explained by case mix (% STEMI admissions).
Conclusions: Standard post-resuscitation care practices approximated AHA guidelines for comprehensive cardiac arrest centers, but with substantial variability of practice among institutions. Where such variability exists, such as the utilization of urgent coronary angiography and revascularization in unresponsive patients at the time of hospital admission, future research should scientifically define best practices.
- © 2011 by American Heart Association, Inc.