Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest

Sunde, Kjetil; Pytte, Morten; Jacobsen, Dag; Mangschau, Arild; Jensen, Lars Petter; Smedsrud, Christian; Draegni, Tomas; Steen, Petter Andreas

doi:10.1016/j.resuscitation.2006.08.016

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Volume 73, Issue 1 , Pages 29-39, April 2007

Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest☆

Kjetil Sunde
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway
- Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway
- Corresponding author at: Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway. Tel.: +47 23016824; fax: +47 23016799.
Morten Pytte
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway
- Institute for Experimental Medical Research, Ulleval University Hospital, Oslo, Norway
Dag Jacobsen
- Department of Acute Medicine, Ulleval University Hospital, Oslo, Norway
Arild Mangschau
- Department of Cardiology, Ulleval University Hospital, Oslo, Norway
Lars Petter Jensen
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway
Christian Smedsrud
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway
Tomas Draegni
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway
Petter Andreas Steen
- Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway

Received 29 June 2006; received in revised form 10 August 2006; accepted 15 August 2006.

Summary

Background

Mortality among patients admitted to hospital after out-of-hospital cardiac arrest (OHCA) is high. Based on recent scientific evidence with a main goal of improving survival, we introduced and implemented a standardised post resuscitation protocol focusing on vital organ function including therapeutic hypothermia, percutaneous coronary intervention (PCI), control of haemodynamics, blood glucose, ventilation and seizures.

Methods

All patients with OHCA of cardiac aetiology admitted to the ICU from September 2003 to May 2005 (intervention period) were included in a prospective, observational study and compared to controls from February 1996 to February 1998.

Results

In the control period 15/58 (26%) survived to hospital discharge with a favourable neurological outcome versus 34 of 61 (56%) in the intervention period (OR 3.61, CI 1.66–7.84, p=0.001). All survivors with a favourable neurological outcome in both groups were still alive 1 year after discharge. Two patients from the control period were revascularised with thrombolytics versus 30 (49%) receiving PCI treatment in the intervention period (47 patients (77%) underwent cardiac angiography). Therapeutic hypothermia was not used in the control period, but 40 of 52 (77%) comatose patients received this treatment in the intervention period.

Conclusions

Discharge rate from hospital, neurological outcome and 1-year survival improved after standardisation of post resuscitation care. Based on a multivariate logistic analysis, hospital treatment in the intervention period was the most important independent predictor of survival.

Abbreviations: BE, base excsess, ED, emergency department, IABP, intra-aortic balloon pump, ICU, intensive care unit, PCI, percutaneous coronary intervention, ROSC, return of spontaneous circulation, SEP, somatosensory evoked potensials, STEMI, ST-elevation myocardial infarction, Volume, colloids and cristalloids