Abstract 310: Early Access to Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm. The Minnesota Resuscitation Consortium Twin Cities Unified Protocol
Background: Cardiac arrest patients that have been successfully resuscitated from shockable rhythms have a high prevalence of thrombotic and/or flow limiting coronary occlusion regardless of the presence of STEMI on the ECG. In 2012 the Minnesota Resuscitation Consortium (MRC) developed an organized approach for the management of all patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL).
Methods: Eleven metropolitan hospitals with 24/7 PCI capabilities agreed to provide early (within 2 hours of arrival to the emergency department) access to the CCL for all patients that were successfully resuscitated from VF/VT arrest regardless of the presence or absence of STEMI on the surface ECG. Inclusion criteria were: witnessed or un-witnessed, age >18 and <70, cardiac arrest of presumed cardiac etiology, comatose or conscious patients. Patients with PEA or asystole, known DNR/DNI, non-cardiac etiology, significant bleeding of any cause, terminal disease were excluded. Patient outcomes were recorded in the state database Cardiac Arrest Registry to Enhance Survival (CARES).
Results: A total of 202 patients were resuscitated and met the inclusion criteria in 2012. Of those, 158 (78%) patients were taken to the CCL per the MRC protocol. Forty-two (20.7%) were not taken to the CCL. Of the patients that had early coronary angiography a total of 42% received primary angioplasty and had at least one vessel disease. A total of 113/158 (72%) were discharged alive and of those 106/113 (94%) were discharged neurologically intact with a cerebral performance category score of 1 or 2. All comatose patients received therapeutic hypothermia. Of the patients that did not gain early access to the CCL, 17/42 (40.5%) survived to hospital discharge and of those, 14/17 (82%) had normal neurological function [OR: 3.69; 1.82-7.48, p=0.0003].
Conclusions: Enabling early access to the catheterization laboratory after cardiac arrest due to a shockable rhythm was associated with 72% survival to hospital discharge and excellent neurological outcomes in a large metropolitan area and real-life clinical practice. Our results support the need for further outcomes based investigation
- © 2012 by American Heart Association, Inc.