Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest

Stub, Dion; Schmicker, Robert H.; Anderson, Monique; Callaway, Clifton W.; Daya, Mohamud; Sayre, Michael R.; Elmer, Jonathan; Grunau, Brian; Aufderheide, Tom P.; Lin, Steve; Buick, Jason E.; Zive, Dana; Peterson, Eric D.; Nichol, Graham; Investigators, Roc

doi:10.1016/j.resuscitation.2015.04.015

Cited by 73 publications

(41 citation statements)

References 49 publications

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“…30,31 Moreover, there may be other therapies given in parallel with PCI and temperature management that likely also improved outcomes among those taken to a cardiac center, including sedation, appropriate oxygenation, and ventilation strategies, establishment of extracorporeal circulation if required, optimization of hemodynamics, glycemic control and other guideline-recommended therapies in addition to timely neurological prognostication, and withdrawal of care. [4][5][6]11 While it is likely a combination of such therapies that benefit resuscitated patients, it is beyond the scope of this study to demonstrate which of these guideline-recommended in-hospital therapies that benefit patients the most. Nonetheless, our data support the transportation of resuscitated patients directly to hospitals, in which this bundle of care is offered, even for longer periods of drive time well beyond 30 minutes.…”

Section: Discussionmentioning

confidence: 98%

“…5,6,[13][14][15][16] While transport to and care at regional cardiac centers have been shown to benefit STEMI patients, only indirect evidence exists that regional systems of care improve care and outcomes for OHCA patients. [5][6][7][8][9][10][11]25,26 We report data from a mixed urban-rural setting in North Carolina, in which a significant number of patients were transported over longer periods of time to arrive to a PCI center. Importantly, characteristics did not substantially differ between patients taken to a PCI center compared with those patients taken to the nearest non-PCI center.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] Nevertheless, evidence supporting bypassing the nearest non-PCI hospital to transport patients directly to a PCI center remains scarce and mostly limited to urban areas with short transport times. [13][14][15][16] Specifically, data on outcomes for patients who bypass a closer, local non-PCI hospital and who are transported for longer periods of time to arrive at specialized centers are warranted.…”

Section: Pci Center and Outcomes After Ohcamentioning

confidence: 99%

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Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Kragholm

Hansen

Dupre

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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O ut-of-hospital cardiac arrest (OHCA) is a major public healthcare issue affecting 200 000 to 400 000 Americans each year, with large variations in incidence, resuscitation practice, and outcomes between communities.1,2 Regional systems of care involving centralization of postresuscitation care have been proposed to improve outcomes because multiple organ systems can be affected after OHCA that likely are best treated at regional centers with percutaneous cardiac intervention (PCI) and critical care capabilities. [3][4][5][6] There is consensus that a regional cardiac arrest center at a minimum must have (1) a cardiac catheterization laboratory that is immediately accessible 24/7 and (2) the capability to provide targeted temperature management (TTM). Background-Practice guidelines recommend regional systems of care for out-of-hospital cardiac arrest. However, whether emergency medical services should bypass nonpercutaneous cardiac intervention (non-PCI) facilities and transport outof-hospital cardiac arrest patients directly to PCI centers despite longer transport time remains unknown. Methods and Results-Using the Cardiac Arrest Registry to Enhance Survival with geocoding of arrest location, we identified out-of-hospital cardiac arrest patients with prehospital return of spontaneous circulation and evaluated the association between direct transport to a PCI center and outcomes in North Carolina during 2012 to 2014. Destination hospital was classified according to PCI center status (catheterization laboratory immediately accessible 24/7). Inverse probability-weighted logistic regression accounting for age, sex, emergency medical services response time, clustering of county, transport time to nearest PCI center, initial heart rhythm, and prehospital ECG information was performed. Of 1507 patients with prehospital return of spontaneous circulation, 1359 (90.2%) were transported to PCI centers, of whom 873 (57.9%) bypassed the nearest non-PCI hospital and 148 (9.8%) were transported to non-PCI hospitals. Discharge survival was higher among those transported to PCI centers (33.5% versus 14.6%; adjusted odds ratio, 2.47; 95% confidence interval, 2.08-2.92). Compared with patients taken to non-PCI hospitals, odds of survival were higher for patients taken to the nearest hospital with PCI center status (odds ratio, 3.07; 95% confidence interval, 1.90-4.97) and for patients bypassing closer hospitals to PCI centers (odds ratio, 3.02; 95% confidence interval, 2.01-4.53). Adjusted survival remained significantly better across transport times of 1 to 5, 6 to 10, 11 to 20, 21 to 30, and >30 minutes. Conclusions-Direct transport to a PCI center is associated with better outcomes for out-of-hospital cardiac arrest patients, even when bypassing nearest hospital and regardless of transport time. (Circ Cardiovasc Qual Outcomes.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Pci Center and Outcomes After Ohcamentioning

confidence: 99%

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Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Kragholm

Hansen

Dupre

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…At this time cooling to a target temperature of 32°C to 34°C is still standard of care in comatose survivors of OHCA, though adoption rates vary between institutions [10].…”

Section: Introductionmentioning

confidence: 99%

Targeted Temperature Management for Survivors of Sudden Cardiac Arrest

Parker¹,

Gottbrecht²,

Gimple³

2017

Pulm Crit Care Med

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“…Lack of standards of care and poor adherence to recommended management for PCAS may be associated with poor outcomes. 7 The purpose of post-cardiac arrest care is to improve the patient's neurologic outcome. We present a scheme of post-cardiac arrest care focusing on brain function in Figure 1.…”

mentioning

confidence: 99%

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima

Hifumi

Kawakita

et al. 2017

Circ J

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The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.

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Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest

Cited by 73 publications

References 49 publications

Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Targeted Temperature Management for Survivors of Sudden Cardiac Arrest

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

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