title: Usefulness of cooling and coronary catheterization to improve survival in out-of-hospital cardiac arrest.
abstract: Survival rates after out-of-hospital cardiac arrest (OHCA) continue to be poor. Recent evidence suggests that a more aggressive approach to postresuscitation care, in particular combining therapeutic hypothermia with early coronary intervention, can improve prognosis. We performed a single-center review of 125 patients who were resuscitated from OHCA in 2 distinct treatment periods, from 2002 to 2003 (control group) and from 2007 to 2009 (contemporary group). Patients in the contemporary group had a higher prevalence of cardiovascular risk factors but similar cardiac arrest duration and prehospital treatment (adrenaline administration and direct cardioversion). Rates of cardiogenic shock (48% vs 41%, p = 0.2) and decreased conscious state on arrival (77% vs 86%, p = 0.2) were similar in the 2 cohorts, as was the incidence of ST-elevation myocardial infarction (33% vs 43%, p = 0.1). The contemporary cohort was more likely to receive therapeutic hypothermia (75% vs 0%, p <0.01), coronary angiography (77% vs 45%, p <0.01), and percutaneous coronary intervention (38% vs 23%, p = 0.03). This contemporary therapeutic strategy was associated with better survival to discharge (64% vs 39%, p <0.01) and improved neurologic recovery (57% vs 29%, p <0.01) and was the only independent predictor of survival (odds ratio 5.5, 95% confidence interval 1.2 to 26.2, p = 0.03). Longer resuscitation time, presence of cardiogenic shock, and decreased conscious state were independent predictors of poor outcomes. In conclusion, modern management of OHCA, including therapeutic hypothermia and early coronary angiography is associated with significant improvement in survival to hospital discharge and neurologic recovery.
authors.affiliation: Alfred Hospital Heart Centre, Melbourne, Victoria, Australia. d.stub@alfred.org.au
authors.forename: Dion
authors.initials: D
authors.lastname: Stub
authors.forename: Christopher
authors.initials: C
authors.lastname: Hengel
authors.forename: William
authors.initials: W
authors.lastname: Chan
authors.forename: Damon
authors.initials: D
authors.lastname: Jackson
authors.forename: Karen
authors.initials: K
authors.lastname: Sanders
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Dart
authors.forename: Andrew
authors.initials: A
authors.lastname: Hilton
authors.forename: Vincent
authors.initials: V
authors.lastname: Pellegrino
authors.forename: James A
authors.initials: JA
authors.lastname: Shaw
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.forename: David M
authors.initials: DM
authors.lastname: Kaye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000401:mortality; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D016022:Case-Control Studies; D004638:Emergency Treatment / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000401:mortality; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014739:Victoria / Q000453:epidemiology
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine