title: Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest.
abstract: BACKGROUND
  The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (≤24h after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA.
  
  
  METHODS
  We performed a secondary analysis of a multicenter clinical trial (NCT00394706) conducted between 2007 and 2009 in 10 North American regions. Subjects were adults (≥18 years) hospitalized after OHCA with pulses sustained ≥60min. We measured the association of early coronary catheterization, percutaneous coronary intervention, fibrinolysis, and induced hypothermia with survival to hospital discharge with favorable functional status (modified Rankin Score≤3).
  
  
  RESULTS
  From 16,875 OHCA subjects, 3981 (23.6%) arrived at 151 hospitals with sustained pulses. 1317 (33.1%) survived to hospital discharge, with 1006 (25.3%) favorable outcomes. Rates of early coronary catheterization (19.2%), coronary reperfusion (17.7%) or induced hypothermia (39.3%) varied among hospitals, and were higher in hospitals treating more subjects per year. Odds of survival and favorable outcome increased with hospital volume (per 5 subjects/year OR 1.06; 95%CI: 1.04-1.08 and OR 1.06; 95%CI: 1.04, 1.08, respectively). Survival and favorable outcome were independently associated with early coronary angiography (OR 1.69; 95%CI 1.06-2.70 and OR 1.87; 95%CI 1.15-3.04), coronary reperfusion (OR 1.94; 95%CI 1.34-2.82 and OR 2.14; 95%CI 1.46-3.14), and induced hypothermia (OR 1.36; 95%CI 1.01-1.83 and OR 1.42; 95%CI 1.04-1.94).
  
  
  CONCLUSIONS
  Early coronary intervention and induced hypothermia are associated with favorable outcome and are more frequent in hospitals that treat higher numbers of OHCA subjects per year.
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: callawaycw@upmc.edu.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: University of Washington, Seattle, WA, United States.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Schmicker
authors.affiliation: University of Washington, Seattle, WA, United States.
authors.forename: Siobhan P
authors.initials: SP
authors.lastname: Brown
authors.affiliation: Legacy Health System, Portland, OR, United States.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Albrich
authors.affiliation: University of British Columbia, Vancouver, BC, United States.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Andrusiek
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI, United States.
authors.forename: Tom P
authors.initials: TP
authors.lastname: Aufderheide
authors.affiliation: University of British Columbia, Vancouver, BC, United States.
authors.forename: James
authors.initials: J
authors.lastname: Christenson
authors.affiliation: Oregon Health and Science University, Portland, OR, United States.
authors.forename: Mohamud R
authors.initials: MR
authors.lastname: Daya
authors.affiliation: University of Toronto, Toronto, ON, United States.
authors.forename: David
authors.initials: D
authors.lastname: Falconer
authors.affiliation: University of California, San Diego, La Jolla, CA, United States.
authors.forename: Ruchika D
authors.initials: RD
authors.lastname: Husa
authors.affiliation: University of Texas, Southwestern, Dallas, TX, United States.
authors.forename: Ahamed H
authors.initials: AH
authors.lastname: Idris
authors.affiliation: Virginia Commonwealth University, Richmond, VA, United States.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Ornato
authors.affiliation: University of Toronto, Toronto, ON, United States.
authors.forename: Valeria E
authors.initials: VE
authors.lastname: Rac
authors.affiliation: University of Washington, Seattle, WA, United States.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.affiliation: University of Washington, Seattle, WA, United States.
authors.forename: Gena
authors.initials: G
authors.lastname: Sears
authors.affiliation: University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, United States.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D020127:Recovery of Function; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Coronary angiography; Fibrinolysis; Heart arrest; Hypothermia; Percutaneous coronary intervention