title: Impact of intensified postresuscitation treatment on outcome of comatose survivors of out-of-hospital cardiac arrest according to initial rhythm.
abstract: OBJECTIVE
  We investigated the impact of intensified postresuscitation treatment in comatose survivors of out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology according to the initial rhythm at the emergency medical team arrival.
  
  
  METHODS
  Interventions and survival with Cerebral Performance Category (CPC) 1-2 within each group were retrospectively compared between the periods of conservative (1995-2003) and intensified (2004-2012) postresuscitation treatment.
  
  
  RESULTS
  In shockable group, therapeutic hypothermia (TH) increased from 1 to 93%, immediate invasive coronary strategy from 28 to 78%, intraaortic balloon pump from 4 to 21%, vasopressors/inotropes from 47 to 81% and antimicrobial agents from 65 to 86% during the intensified period as compared to conservative period (p<0.001). This was associated with increased survival with CPC 1-2 from 27 to 47% (p<0.001). After adjusting for age, sex and prehospital confounders, TH (OR=2.12, 95% CI 1.25-3.61), percutaneous coronary intervention (OR 1.77, 95% CI 1.15-2.73) and antimicrobial agents (OR=12.21, 95% CI 5.13-29.08) remained associated with survival with CPC 1-2. In non-shockable patients, TH also significantly increased from 1 to 74%, immediate invasive coronary strategy from 8 to 51%, intraaortic balloon pump from 2 to 9% and vasopressors/inotropes from 56 to 84% during intensified period without concomitant increase in survival with CPC 1-2 (7% vs. 9%; p=0.27). After adjustment, only antimicrobial agents (OR=8.43, 95% CI: 1.05-67.72) remained associated with survival with CPC 1-2.
  
  
  CONCLUSIONS
  Intensified postresuscitation treatment was associated with doubled survival in comatose survivors of OHCA with shockable rhythm. Such association could not be demonstrated in patients with non-shockable rhythm.
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
authors.forename: Spela Tadel
authors.initials: ST
authors.lastname: Kocjancic
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
authors.forename: Anja
authors.initials: A
authors.lastname: Jazbec
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia. Electronic address: marko.noc@mf.uni-lj.si.
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
mesh_terms: D000368:Aged; D003128:Coma / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000628:therapy*; D012151:Resuscitation; D012189:Retrospective Studies; D017741:Survivors; D017180:Tachycardia, Ventricular / Q000150:complications / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000150:complications / Q000503:physiopathology
keywords: Cardiac arrest; Cerebral performance category; Comatose survivors; Hypothermia; Percutaneous coronary intervention; Postresuscitation care