Abstract 308: There is a Correlation Between Neurologic Score and Discharge Location for Patients With Out-of-Hospital Cardiac Arrest of Presumed Cardiac Origin
Background: The Circulation Improving Resuscitation Care (CIRC) Trial found equivalent survival in out-of-hospital cardiac arrest (OHCA) patients who received integrated AutoPulse CPR (iA-CPR) compared to high quality Manual CPR (M-CPR), and no difference in neurologic outcome. However, neurologic outcome was not available for some patients, and discharge location may serve as a proxy for neurologic outcome. The objective of this study was to determine if there is a correlation between modified Rankin Scale (mRS) Score at discharge and discharge location, and to determine the association between discharge location and study intervention.
Methods: A subgroup-analysis of the CIRC randomized clinical trial comparing iA-CPR to M-CPR was conducted on patients who were discharged from hospital. Neurologic outcome was categorized as good (mRS ≤3), not good (mRS ≥4), or unknown, and according to discharge location of home or rehabilitation, nursing home or assisted living, and unknown or awaiting care, respectively. Spearman correlation was used to determine the relationship between mRS score and discharge location. Logistic Regression was used to compare iA-CPR to M-CPR in predicting neurologic outcome using discharge location and adjusting for the study covariates (study site, patient age, witnessed arrest, and initial rhythm).
Results: CIRC enrolled 4,231 patients and 429 (10%) survived to hospital discharge. mRS score was known for 310 of those patients and discharge location for 300 patients, both were known for 292. A Spearman correlation analysis between mRS score and discharge location was statistically significant (r=0.622, p<0.001). iA-CPR was documented to increase survival to hospital discharge with good neurologic outcome (using discharge location as a surrogate) compared to M-CPR (unadjusted OR 2.25, 95% CI 1.21-4.17, p=0.009). When adjusted for covariates there was a trend in favor of iA-CPR (OR 1.82, 95% CI 0.91-3.63, p=0.09).
Conclusion: There was a correlation between mRS score and discharge location. More patients were discharged to a location with limited assistance and consequently potential better neurologic outcome in the iA-CPR group compared to the high quality M-CPR group.
- © 2013 by American Heart Association, Inc.