Abstract 59: Treatment at a STEMI Center Is Associated with Favorable Outcomes Following Out-of-Hospital Cardiac Arrest
Introduction: The American Heart Association recommends regionalized post-OOHCA care at cardiac resuscitation centers that are closely aligned with ST elevation myocardial infarction (STEMI) centers. However, the effect of STEMI centers on outcomes following OOHCA remains unknown.
Hypothesis: We hypothesize that treatment at a STEMI center is associated with increased survival and neurologic recovery among OOHCA patients.
Methods: We included patients age 18 years or older with OOHCA in the 2010 California Emergency Medical Services Information Systems (CEMSIS) database whose CEMSIS record was linked to an inpatient record from the California Office of Statewide Health Planning and Development (OHSPD) database. The CEMSIS database is a unified EMS data collection system, and the OSHPD database contains patient-level data for all inpatient and emergency department encounters. We linked CEMSIS and OSHPD records using probabilistic linkage. Multiple logistic regression models including age, sex, race, ethnicity, payer category, hospital size, teaching status, and trauma center status were used to evaluate the association between STEMI center treatment and outcomes. A STEMI center was defined as one with 24-7 percutaneous coronary intervention capability. Good neurologic recovery was defined as discharge to home, residential care facility, psychiatric facility, prison/jail, and against medical advice.
Results: We identified 8481 patients with OOHCA in the CEMSIS database; 3620 were linked to OSHPD inpatient records. The majority (74.0%) were treated at STEMI centers. Median age was 73 years (IQR 60-83). Survival to hospital discharge was similar between the two groups (26.3% vs 25.8%; p=0.76), but good neurologic recovery was higher among those treated at STEMI centers (18.2% vs 10.4%; p<0.0001). In the adjusted analysis, treatment at a STEMI center was associated with survival (OR 1.2, 95% CI 1.0-1.5; p=0.047) and good neurologic recovery (OR 2.1, 95% CI 1.6-2.8; p<0.0001).
Conclusions: Treatment at a STEMI center following OOHCA was associated with favorable outcomes recovery. Our data suggest that regionalized post-OOHCA care in accordance with American Heart Association guidelines may improve neurologic recovery following OOHCA.
- © 2012 by American Heart Association, Inc.