Abstract 18123: An Integrated Resuscitation Service, Combining a Specialist Pre-Hospital Physician Response Unit With Delivery to a Dedicated High-Volume Cardiac Arrest Centre, Optimises Survival Following Cardiac Arrest
Background: Despite advances in resuscitation medicine, survival rates to discharge following out-of-hospital cardiac arrest (OHCA) remain poor. Recent data support early critical care interventions including therapeutic hypothermia (TH) and immediate percutaneous coronary intervention (PCI). In London, a package of high quality physician-led critical care intervention on scene, with the capacity to transfer these patients direct to a PCI centre, is available through the deployment of London’s Air Ambulance specialist Physician Response Unit (PRU).
Methods: Prospective data was gathered on OHCA treated by the PRU, which were transferred to a single PCI centre. Data included patient demographics, clinical characteristics, interventions and outcome.
Results: Between April 2011 and April 2013, data was obtained on 20 patients, with a mean age of 59. Clinical characteristics - presenting rhythm: VF 65%, asystole 15%, PEA 15%, VT 5%. Return of spontaneous circulation (ROSC) was achieved at scene in 75%. PRU interventions: Advanced airway management 90%, rapid sequence induction 50%, early TH 45%, mechanical CPR (mCPR) during transfer 15%. Overall survival to ICU was 50%, with overall survival to discharge 45%. Of those patients who underwent emergency angiography, 71% survived to ICU, with 64% surviving to discharge. Of patients presenting in VF, 62% survived to discharge. Interestingly, 66% of patients who received TH survived to discharge, compared with 45% where TH was not used. All patients who underwent successful PCI survived to discharge with good neurological outcomes.
9 patients had a confirmed single vessel culprit lesion treated by PCI, one patient had complex mutlivessel disease complicated by cardiogenic shock and underwent mutivessel PCI, and 2 patients had an undiagnosed underlying cardiomyopathy.
Conclusions: In selected cases, outcomes following OHCA can be optimized by integrating a PRU cardiac arrest service, enabling direct triage of patients to a cardiac arrest centre, with early application of neuroprotective strategies, mCPR, circulatory support and interventional cardiology techniques.
- © 2013 by American Heart Association, Inc.