Abstract
Aim
We investigated the impact of intensified postresuscitation treatment in comatose
survivors of out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology according
to the initial rhythm at the emergency medical team arrival.
Methods
Interventions and survival with Cerebral Performance Category (CPC) 1–2 within each
group were retrospectively compared between the periods of conservative (1995–2003)
and intensified (2004–2012) postresuscitation treatment.
Results
In shockable group, therapeutic hypothermia (TH) increased from 1 to 93%, immediate
invasive coronary strategy from 28 to 78%, intraaortic balloon pump from 4 to 21%,
vasopressors/inotropes from 47 to 81% and antimicrobial agents from 65 to 86% during
the intensified period as compared to conservative period (p < 0.001). This was associated with increased survival with CPC 1–2 from 27 to 47% (p < 0.001). After adjusting for age, sex and prehospital confounders, TH (OR = 2.12, 95% CI 1.25–3.61), percutaneous coronary intervention (OR 1.77, 95% CI 1.15–2.73)
and antimicrobial agents (OR = 12.21, 95% CI 5.13–29.08) remained associated with survival with CPC 1–2. In non-shockable
patients, TH also significantly increased from 1 to 74%, immediate invasive coronary
strategy from 8 to 51%, intraaortic balloon pump from 2 to 9% and vasopressors/inotropes
from 56 to 84% during intensified period without concomitant increase in survival
with CPC 1–2 (7% vs. 9%; p = 0.27). After adjustment, only antimicrobial agents (OR = 8.43, 95% CI: 1.05–67.72) remained associated with survival with CPC 1–2.
Conclusion
Intensified postresuscitation treatment was associated with doubled survival in comatose
survivors of OHCA with shockable rhythm. Such association could not be demonstrated
in patients with non-shockable rhythm.
Keywords
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References
- ERC guidelines writing group. European Resuscitation Council guidelines for Resuscitation 2010 Section 1. Executive summary.Resuscitation. 2010; 81: 1219-1276
- Survival of patients with out-of-hospital cardiac arrest in Ljubljana: outcome report according to the Utstein style.Resuscitation. 1998; 38: 169-176
- Out-of-hospital cardiac arrest. Evaluation of one year of activity in Saint-Etienne's emergency medical system using the Utstein style.Resuscitation. 1996; 33: 19-27
- Outcome of out-of-hospital cardiorespiratory arrest in South Glamorgan.Resuscitation. 1997; 34: 227-233
- Out-of-hospital cardiac arrest in Helsinki: Utstein style reporting.Heart. 1996; 18: 18-23
- Outcome of out-of-hospital cardiac arrest in New York City. The prehospital arrest survival evaluation (PHASE) study.JAMA. 1994; 271: 678-683
- Rescue percutaneous coronary intervention during cardiopulmonary resuscitation.Resuscitation. 2004; 61: 231
- Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.N Engl J Med. 2002; 346: 549-556
- Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.N Engl J Med. 2002; 346: 557-563
- Strong and weak aspects of an established post-resuscitation treatment protocol—a five year observational study.Resuscitation. 2011; 82: 1186-1193
- Implementation of a standardized treatment protocol for postresuscitation care after out-of-hospital cardiac arrest.Resuscitation. 2007; 73: 29-39
- Usefulness of cooling and coronary catheterization to improve survival in out-of-hospital cardiac arrest.Am J Cardiol. 2011; 107: 522-527
- A statement for health professionals from a Task Force of the Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The Utstein Style.Circulation. 1991; 84: 960-975
- Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction.Resuscitation. 2007; 74: 227-234
- Angiographic characteristics of coronary disease and postresuscitation electrocardiograms in patients with aborted cardiac arrest outside a hospital.Am J Cardiol. 2011; 108: 634-638
- Acute ST-elevation myocardial infarction after successful cardiopulmonary resuscitation.Resuscitation. 2007; 72: 379-385
- Should we use postresuscitation ECG to decide for immediate invasive coronary strategy after resuscitated cardiac arrest?.Resuscitation. 2013; 84: 1169-1170
- Survival in out-of-hospital cardiac arrest before and after use of advanced postresuscitation care: a survey focusing on incidence, patient characteristics, survival, and estimated cerebral function after postresuscitation care.Am J Emerg Med. 2010; 28: 543-551
- Is hypothermia after cardiac arrest effective in both shockable and nonshockable patients? Insights from large registry.Circulation. 2011; 123: 877-886
- Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms? A systematic review and meta-analysis of randomized and non-randomized studies.Resuscitation. 2012; 83: 188-196
- Impact of changes in resuscitation practice on survival and neurological outcome after out-of-hospital cardiac arrest resulting from nonshockable arrhythmias.Circulation. 2012; 125: 1787-1794
- Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms.Resuscitation. 2012; 83: 202-207
- Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest—a systematic review and meta-analysis.Resuscitation. 2012; 83: 1427-1433
- Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest.Resuscitation. 2014; 85: 657-663
- Early antibiotics improve survival: following out-of-hospital cardiac arrest.Resuscitation. 2013; 84: 616-619
- Moderate hypothermia for severe cardiogenic shock (COOL Shock Study I&II).Resuscitation. 2013; 84: 319-325
- Targeted temperature management at 33 °C versus 36 °C after cardiac arrest.N Engl J Med. 2013; 369: 2197-2206
- Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial.JAMA. 2014; 311: 45-52
Article info
Publication history
Published online: July 07, 2014
Accepted:
June 22,
2014
Received in revised form:
June 11,
2014
Received:
April 23,
2014
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.06.028.
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
