Abstract 18627: Trends in Use of Advanced Therapies and Mortality in Adults Hospitalized With Cardiac Arrest
Introduction: While substantial advances have been made in the management of cardiac arrest (CA), little is known regarding the prevalence of these advancements and their impact on inpatient outcomes over time. We sought to examine temporal trends in in-hospital mortality and use of advanced therapies (i.e. extracorporeal membrane oxygenation (ECMO), therapeutic hypothermia (TH), coronary angiogram, and coronary revascularization) in adults hospitalized with CA.
Methods: The Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample was utilized to identify a cohort of adults hospitalized with CA, identified through International Classification of Diseases-9 codes. Baseline demographics, medical history, and clinical outcomes were assessed in 942,495 hospitalizations in adults with CA from 2006-2012.
Results: In-hospital all-cause mortality significantly decreased over the 7-year study period (65.5%, 63.4%, 59.3%, 57.9%, and 57.0%, 56.0%, and 56.3% from 2006-2012). From 2006-2012, there was an overall rise in the use of coronary angiogram (12.8%, 13.0%, 14.7%, 15.0%, 14.3%, 14.7%, and 15.8%), percutaneous coronary intervention (PCI) (7.5%, 7.1%, 8.4%, 8.1%, 8.1%, 8.4%, and 8.9%), TH (0.2%, 0.3%, 0.6%, 1.2%, 1.9%, 2.8%, and 3.0%), and ECMO (0.1%, 0.1%, 0.1%, 0.2%, 0.2%, 0.3%, and 0.4%). Predictors of mortality included older age, male gender, black race, coronary artery disease (CAD), peripheral arterial disease, cerebrovascular disease, congestive heart failure, atrial fibrillation, chronic obstructive lung disease, and HIV/AIDS and absence of certain comorbidities (i.e. prior myocardial infarction, prior coronary revascularization, diabetes mellitus, chronic kidney disease, smoking, obstructive sleep apnea, obesity, and metabolic syndrome). Younger age and CAD were the strongest predictors of use of ECMO, TH, and coronary angiogram.
Conclusions: During 2006-2012, a decline in mortality was accompanied by a steady rise in use of advanced therapies, including ECMO, TH, coronary angiogram, and coronary revascularization. Patients of younger age and with CAD were more likely to receive these advanced therapies.
- Cardiac arrest
- Extracorporeal circulation
- Therapeutic hypothermia
- Percutaneous coronary intervention (PCI)
Author Disclosures: J.K. Patel: None. H. Meng: None. P.B. Parikh: None.
- © 2016 by American Heart Association, Inc.