Abstract 154: Association of Hospital Care with Survival and Functional Recovery After Out-of-Hospital Cardiac Arrest
Introduction. Guidelines recommend induced hypothermia and coronary reperfusion after out-of-hospital cardiac arrest (OHCA), but the impact of in-hospital treatments is unknown. This study (1) determined the rate of cardiac catheterization, coronary reperfusion, and induced hypothermia after OHCA, and (2) tested the hypothesis that interventions are associated with survival and functional recovery.
Methods. Secondary analysis of the Resuscitation Outcomes Consortium-PRIMED trial conducted between June 2007 and October 2009 in 10 North American sites. Subjects were adults (>=18 years or age of consent) hospitalized after OHCA who sustained pulses >=1 hour. Interventions were acute (<=24 hours after arrival) cardiac catheterization, coronary reperfusion (percutaneous coronary interventions or fibrinolytic drugs), and induced hypothermia. Main outcome was survival to hospital discharge, and secondary outcome was favorable functional status (modified Rankin Score<=3). Frequencies of events were calculated, and associations measured with multivariable logistic regression adjusted for age, sex, response interval, initial ECG rhythm, witnessed collapse, bystander CPR, hospital size and site.
Results. Of 16875 OHCA subjects, 3981 (23.6%) arrived at 150 hospitals with sustained pulses. Of hospitalized subjects, 1173 (32.9%) survived to discharge, with 894 (25.0%) having favorable functional status. A minority of subjects received acute cardiac catheterization (19.2%), coronary reperfusion (17.7%) or induced hypothermia (39.3%), and therapies were more frequent in hospitals that treated more subjects. Survival and favorable functional outcome were more frequent with acute cardiac catheterization (62.7%, 54.0%), coronary reperfusion (65.8%, 57.4%) and induced hypothermia (39.3%, 30.4%). In multivariable analysis, survival was associated with acute cardiac catheterization (OR 1.57; 95%CI 1.14-2.16), coronary reperfusion (OR 2.02; 95%CI 1.58-2.58), but not hypothermia (OR 0.88; 95%CI 0.73-1.07).
Conclusions. Rates of acute cardiac catheterization and induced hypothermia after OHCA are low. Cardiac catheterization and coronary reperfusion are associated with increased survival and functional recovery.
- © 2012 by American Heart Association, Inc.