Abstract 282: Postresuscitation Care in a Quaternary Intensive Care Unit
Objectives: To identify factors associated with survival to hospital discharge admission to intensive care after cardiac arrest in 2014.
Methods: Patients with cardiac arrest admitted to an Intensive Care Unit (ICU) from December 2013 to May 2014 were followed throughout their hospital admission. Demographic information and key factors known to impact outcomes were extracted from patient records. The primary endpoint was survival to hospital discharge, and the secondary endpoint was neurological outcome as assessed by cerebral performance category (CPC).
Results: Fifty-five patients were admitted to the Intensive Care Unit at Royal Melbourne Hospital between December 2013 and May 2014. Out-of-hospital cardiac arrests accounted for 36/55 (65%) of the patients. Overall survival to hospital discharge was 27/55 (49%, 95%CI 35-63%), with 23/27 (85%, 71-100%) of survivors having a good neurological outcome (defined as CPC 1 or 2) at discharge. The initial rhythm was shockable in 20/55 (36%, 23-49%). The median time to CPR was 1 (Inter-Quartile Range 0-5) minute and the total time from arrest to Return of Spontaneous Circulation was 19 (10-31) minutes.
Arrest factors associated with improved survival included: an initial shockable rhythm (OR 14.17, 95%CI 3.39-59.19), female gender (OR 4.98, 1.36-18.21), witnessed arrest (OR 4.44, 1.08-18.53), and shorter time from arrest to ROSC (p<0.05). Therapeutic hypothermia was initiated in 45% of patients and was associated with increased survival (OR 3.07, 1.02-9.26). Coronary catheterisation was undertaken in 35% of patients and was also associated with improved survival (OR 12.12, 2.92-50.27) and good neurological outcome (OR 8.40, 2.36-29.90). Early hypotension occurred in 39% of patients and was associated with decreased survival (OR 0.13, 0.04-0.51) and worse neurological outcome (OR 0.13, 0.03-0.52). Oxygenation and ventilation parameters were not associated with survival.
Conclusions: Approximately half the patients who reach ICU alive after in- and out-of-hospital cardiac arrests survive neurologically intact to hospital discharge. Careful post-resuscitation management appears to improve survival.
Author Disclosures: H.F. O’Regan: None. P. Morley: None.
- © 2014 by American Heart Association, Inc.