Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest.
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.
Sunde
Kjetil
K
Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway. kjetil.sunde@medisin.uio.no
Pytte
Morten
M
Jacobsen
Dag
D
Mangschau
Arild
A
Jensen
Lars Petter
LP
Smedsrud
Christian
C
Draegni
Tomas
T
Steen
Petter Andreas
PA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000032:analysis; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D002985:Clinical Protocols; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007036:Hypothermia, Induced; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial; D012640:Seizures / Q000517:prevention & control; D016019:Survival Analysis; D015912:Thrombolytic Therapy
D001786:Blood Glucose