title: Survival and neurologic outcome after out-of-hospital cardiac arrest: results one year after regionalization of post-cardiac arrest care in a large metropolitan area.
abstract: BACKGROUND
  Post-resuscitation care of cardiac arrest patients at specialized centers may improve outcome after out-of-hospital cardiac arrest (OOHCA). This study describes experience with regionalized care of resuscitated patients.
  
  
  METHODS
  Los Angeles (LA) County established regionalized cardiac care in 2006. Since 2010, protocols mandate transport of nontraumatic OOHCA patients with field return of spontaneous circulation (ROSC) to a STEMI Receiving Center (SRC) with a hypothermia protocol. All SRC report outcomes to a registry maintained by the LA County Emergency Medical Services (EMS) Agency. We report the first year's data. The primary outcome was survival with good neurologic outcome, defined by a Cerebral Performance Category (CPC) score of 1 or 2.
  
  
  RESULTS
  The SRC treated 927 patients from April 2011 through March 2012 with median age 67; 38% were female. There were 342 patients (37%) who survived to hospital discharge. CPC scores were unknown in 47 patients. Of the 880 patients with known CPC scores, 197 (22%) survived to hospital discharge with a CPC score of 1 or 2. The initial rhythm was VF/VT in 311 (34%) patients, of whom 275 (88%) were witnessed. For patients with an initial shockable rhythm, 183 (59%) survived to hospital discharge and 120 (41%) had survival with good neurologic outcome. Excluding patients who were alert or died in the ED, 165 (71%) patients with shockable rhythms received therapeutic hypothermia (TH), of whom 67 (42%) had survival with good neurologic outcome. Overall, 387 patients (42%) received TH. In the TH group, the adjusted OR for CPC 1 or 2 was 2.0 (95%CI 1.2-3.5, p = 0.01), compared with no TH. In contrast, the proportion of survival with good neurologic outcome in the City of LA in 2001 for all witnessed arrests (irrespective of field ROSC) with a shockable rhythm was 6%.
  
  
  CONCLUSIONS
  We found higher rates of neurologically intact survival from OOHCA in our system after regionalization of post-resuscitation care as compared to historical data.
authors.forename: Nichole
authors.initials: N
authors.lastname: Bosson
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.forename: James T
authors.initials: JT
authors.lastname: Niemann
authors.forename: Marc
authors.initials: M
authors.lastname: Eckstein
authors.forename: Paula
authors.initials: P
authors.lastname: Rashi
authors.forename: Richard
authors.initials: R
authors.lastname: Tadeo
authors.forename: Deidre
authors.initials: D
authors.lastname: Gorospe
authors.forename: Gene
authors.initials: G
authors.lastname: Sung
authors.forename: William J
authors.initials: WJ
authors.lastname: French
authors.forename: David
authors.initials: D
authors.lastname: Shavelle
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Thomas
authors.forename: William
authors.initials: W
authors.lastname: Koenig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002300:Cardiac Care Facilities / Q000592:standards / Q000600:supply & distribution*; D006328:Cardiac Catheterization; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000592:standards / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000592:standards / Q000706:statistics & numerical data; D012040:Regional Health Planning; D016019:Survival Analysis