Abstract
Background
The survival rate of out-of-hospital cardiac arrest (OHCA) remains extremely low,
generally under 10%. Post-resuscitation care, and particularly early coronary reperfusion,
may improve this outcome. The main objective of the present study was to determine
whether patients with immediate coronary angiography at hospital admission (CAA) had
a better outcome than patients without immediate CAA.
Methods
This cohort analysis study was based on data extracted from the French National Cardiac
Arrest registry (RéAC). To control for attribution bias, patients were matched using
a propensity score, which included age clusters, low flow and no flow delays, initial
rhythm and bystander cardiopulmonary resuscitation (CPR). The main endpoint was survival
at day 30 (D30). Secondary endpoint was neurological recovery of survivors assessed
by the Cerebral Performance Category (CPC) scale, with CPC 1 and 2 at D30 considered
as a favorable outcome.
Results
From July 1st, 2011 to October 1st, 2016, 63394 OHCA were registered in the database,
of which 39444 were of an unknown or suspected cardiac origin. After on-site resuscitation
by a mobile medical team, 7584 patients were transported to a hospital facility. Among
these patients, 4046 were retained in the analysis after matching for the aforementioned
factors and constituted into 2 groups: immediate coronary angiography (iCAA) group
(n = 2023) and non-immediate coronary angiography (niCAA) group (n = 2023). The survival
rate at D30 after matching was 43.3% in the iCAA group versus 34.5% in the niCAA group
(OD = 0.66 [0.58; 0.75], p < 0.001). In the iCAA group, (n = 707) 36% of the patients
at D30 were CPC 1–2 comparatively to (n = 539) 27.3% in the niCAA group (p < 0.01).
Conclusions
Both the survival and proportion of patients with favorable neurological recovery
were significantly higher in patients who underwent an immediate coronary angiography
after a resuscitated OHCA. These observational results warrant further exploration
of the benefit of this invasive strategy in randomized studies.
Keywords
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References
- Cardiac arrest in France: why a national register?.Presse Médicale Paris Fr 1983. 2011; 40: 634-638
- Incidence of EMS-treated out-of-hospital cardiac arrest in Europe.Resuscitation. 2005; 67: 75-80
- Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.Resuscitation. 2010; 81: 1479-1487
- Survival after out-of-hospital cardiac arrest in relation to sex: a nationwide registry-based study.Resuscitation. 2014; 85: 1212-1218
- Out of hospital cardiac arrest in Vienna: incidence and outcome.Resuscitation. 2013; 84: 42-47
- Cardiac arrest resuscitation evaluation in Los Angeles: CARE-LA.Ann Emerg Med. 2005; 45: 504-509
- Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Resuscitation. 2015; 95: e71-120
- A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction Study Group.N Engl J Med. 1993; 328: 673-679
- European resuscitation council and european society of intensive care medicine guidelines for post-resuscitation care 2015.Resuscitation. 2015; 95: 202-222
- Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: review and meta-analysis.Resuscitation. 2014; 85: 1533-1540
- Early coronary angiography and survival after out-of-hospital cardiac arrest.Circ Cardiovasc Interv. 2015; 8https://doi.org/10.1161/CIRCINTERVENTIONS.114.002321
- Immediate percutaneous coronary intervention is associated with improved short- and long-term survival after out-of-hospital cardiac arrest.Circ Cardiovasc Interv. 2015; 8https://doi.org/10.1161/CIRCINTERVENTIONS.114.002303
- Association of emergent and elective percutaneous coronary intervention with neurological outcome and survival after out-of-hospital cardiac arrest in patients with and without a history of heart disease.Resuscitation. 2015; 97: 115-121
- Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian region out of hospital cardiac arrest) registry.Circ Cardiovasc Interv. 2010; 3: 200-207
- Rationale, methodology, implementation, and first results of the french out-of-hospital cardiac arrest registry.Prehosp Emerg Care. 2014; 18: 511-519
- Recommended guidelines for uniform reporting of data from out-of- hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.Circulation. 1991; 84: 960-975
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the utstein templates for resuscitation registries: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).Circulation. 2004; 110: 3385-3397
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.Circulation. 2015; 132: 1286-1300
- European resuscitation council guidelines for resuscitation 2015.Resuscitation. 2015; : 1-80
- Recent developments in the management of patients resuscitated from cardiac arrest.J Crit Care. 2017; 39: 97-107
- Sudden death due to cardiac arrhythmias.N Engl J Med. 2001; 345: 1473-1482
- Experimental models of ventricular tachycardia and fibrillation caused by ischemia and infarction.Circulation. 1992; 85: I32-42
- European resuscitation council guidelines for resuscitation 2010 Section 1. Executive summary.Resuscitation. 2010; 81: 1219-1276
- Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European association for percutaneous cardiovascular interventions (EAPCI)/stent for life (SFL) groups.EuroIntervention. 2014; 10: 31-37
- Emergency percutaneous coronary intervention in post–cardiac arrest patients without ST-segment elevation pattern.JACC Cardiovasc Interv. 2016; 9: 1011-1018
- Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.N Engl J Med. 1997; 336: 1629-1633
- Angiographic characteristics of coronary disease and postresuscitation electrocardiograms in patients with aborted cardiac arrest outside a hospital.Am J Cardiol. 2011; 108: 634-638
- Emergency coronary angiography in comatose cardiac arrest patients: do real-life experiences support the guidelines?.Eur Heart J Acute Cardiovasc Care. 2012; 1: 291-301
- Incidence of coronary intervention in cardiac arrest survivors with non-shockable initial rhythms and no evidence of ST-elevation MI (STEMI).Resuscitation. 2017; 113: 83-86
- Comparison of role of early (less than six hours) to later (more than six hours) or no cardiac catheterization after resuscitation from out-of-hospital cardiac arrest.Am J Cardiol. 2012; 109: 451-454
- Editor’s choice-is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?.Eur Heart J Acute Cardiovasc Care. 2016; 5: 317-326
Article info
Publication history
Published online: March 05, 2018
Accepted:
March 2,
2018
Received in revised form:
February 18,
2018
Received:
December 24,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.03.003.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
