Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest

Callaway, Clifton W.; Schmicker, Robert H.; Brown, Siobhan P.; Albrich, Jennifer; Andrusiek, Douglas; Aufderheide, Tom P.; Christenson, James M.; Daya, Mohamud; Falconer, David; Husa, Ruchika; Idris, Ahamed H.; Ornato, Joseph P.; Rac, Valeria E.; Rea, Thomas D.; Rittenberger, Jon C.; Sears, Gena K.; Stiell, Ian G.

doi:10.1016/j.resuscitation.2013.12.028

Cited by 161 publications

(119 citation statements)

References 36 publications

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“…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: 99%

Section: Pci Center and Outcomes After Ohcamentioning

confidence: 99%

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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“…96 As a consequence, the proportion of patients who undergo emergent angiography may not include all of those who the data suggest may benefit from it. 30,98 Experts have recommended disaggregating patients with OHCA from public reporting of outcomes after STEMI to reduce unintended consequences. 96 Ongoing efforts are warranted to understand and disseminate appropriate use of emergent angiography in patients resuscitated from OHCA.…”

Section: Referring and Receiving Facilitiesmentioning

confidence: 99%

“…28 In a large metropolitan area in the United Kingdom, patients with STEMI complicated by OHCA who were resuscitated and then transported to a specialist STEMI center for angiography and selective PCI had a high rate of survival (66%). 29 In a secondary analysis of data from a multicenter randomized trial of field interventions in patients with OHCA, 30 use of hospital-based intervention was observed but not mandated or randomly allocated. Rates of early coronary catheterization (19.2%), coronary reperfusion (17.7%), and induced hypothermia (39.3%) varied among hospitals and were higher in hospitals treating more patients per year.…”

mentioning

confidence: 99%

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

McCarthy¹,

Carr²,

Sasson³

et al. 2018

Circulation

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ABSTRACT:The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation.1 Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States.2 One third of cases occur without any prior recognized heart disease; half occur without any prodromal symptoms.3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care.4-6 As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care. The American Heart Association (AHA) previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, EMS, and hospital efforts to measure and improve the process and outcome of care for patients with cardiac arrest.10 Simultaneously, the AHA proposed a national process to develop and implement evidence-based guidelines for the implementation and measurement of such systems. The 2015 AHA guidelines for CPR and emergency cardiovascular care delved deeper into the elements of an effective system of care for both OHCA and in-hospital cardiac arrest.11 This update on OHCA resuscitation systems of care describes recent advances, evidence

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“…The authors identified grants using the NIH public database and included grants based on their abstracts that specifically addressed cardiac arrest or CPR. When CPR does restore heart function, patients may have dysfunction in multiple organ systems as a result of ischemia–reperfusion,3 and injury to the brain accounts for the majority of post‐CPR mortality 4, 5. To study this particular situation, the authors also included projects that studied global brain ischemia.…”

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confidence: 99%

Increasing National Institutes of Health Funding for Cardiac Arrest Research

Callaway

2017

JAHA

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Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest

Cited by 161 publications

References 36 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

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Increasing National Institutes of Health Funding for Cardiac Arrest Research

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