title: Level of consciousness on admission to a Heart Attack Centre is a predictor of survival from out-of-hospital cardiac arrest.
abstract: BACKGROUND
  The relationship between the neurological status at the time of handover from the ambulance crew to a Heart Attack Centre (HAC) in patients who have achieved return of spontaneous circulation (ROSC) and subsequent outcome, in the context of current treatment standards, is unknown.
  
  
  METHODS
  A retrospective review of all patients treated by London Ambulance Service (LAS) from 1(st) April 2011 to 31(st) March 2013 admitted to a HAC in Greater London was undertaken. Neurological status (A - alert; V - responding to voice; P - responding to pain; U - unresponsive) recorded by the ambulance crew on handover was compared with length of hospital stay and survival to hospital discharge.
  
  
  RESULTS
  A total of 475 sequential adult cardiac arrests of presumed cardiac origin, achieving ROSC on admission to a HAC were identified. Outcome data was available for 452 patients, of whom 253 (56.0%) survived to discharge. Level of consciousness on admission to the HAC was a predictor of duration of hospital stay (P<0.0001) and survival to hospital discharge (P<0.0001). Of those presenting with a shockable rhythm, 32.3% (120/371) were 'A' or 'V', compared with 9.1% (9/99) of those with non-shockable rhythms (P<0.001).
  
  
  CONCLUSIONS
  Patients with shockable rhythms achieving ROSC are more likely to be conscious (A or V) compared with those with non-shockable rhythms. Most patients who are conscious on admission to the HAC will survive, compared with approximately half of those who are unconscious (P or U), suggesting that critical care is generally appropriate at all levels of consciousness if ROSC has been achieved.
authors.affiliation: Clinical Directorate, South Central Ambulance Service, Southern House, Otterbourne SO21 2RU, United Kingdom; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom. Electronic address: charlesdeakin@doctors.org.uk.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Deakin
authors.affiliation: Clinical Audit and Research Unit, London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 0BW, United Kingdom.
authors.forename: Rachael
authors.initials: R
authors.lastname: Fothergill
authors.affiliation: London Ambulance Service NHS Trust HQ, 220 Waterloo Road, London SE1 8SD, United Kingdom.
authors.forename: Fionna
authors.initials: F
authors.lastname: Moore
authors.affiliation: Clinical Audit and Research Unit, London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 0BW, United Kingdom.
authors.forename: Lynne
authors.initials: L
authors.lastname: Watson
authors.affiliation: Medical Directorate, London Ambulance Service NHS Trust, 8-20 Pocock Street, London SE1 0BW, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Whitbread
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation; D003243:Consciousness / Q000502:physiology*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology* / Q000628:therapy; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D006113:United Kingdom
keywords: Ambulance; Cardiac arrest; Level of consciousness; Out-of-hospital; Outcome; Return of spontaneous circulation; Survival