title: Long-term outcome of patients after out-of-hospital cardiac arrest in relation to treatment: a single-centre study.
abstract: BACKGROUND
  Outcome after out-of-hospital cardiac arrest (OHCA) remains poor. With the introduction of automated external defibrillators, percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) the prognosis of patients after OHCA appears to be improving. The aim of this study was to evaluate short and long-term outcome among a non-selected population of patients who experienced OHCA and were admitted to a hospital working within a ST elevation myocardial infarction network.
  
  
  METHODS
  All patients who achieved return of spontaneous circulation (ROSC) (n=456) admitted to one hospital after OHCA were included. Initial rhythm, reperfusion therapy with PCI, implementation of MTH and additional medical management were recorded. The primary outcome measure was survival (hospital and long term). Neurological status was measured as cerebral performance category. The inclusion period was January 2003 to August 2010. Follow-up was complete until April 2014.
  
  
  RESULTS
  The mean patient age was 63±14 years and 327 (72%) were men. The initial rhythm was ventricular fibrillation, pulseless electrical activity, asystole and pulseless ventricular tachycardia in 322 (71%), 58 (13%), 55 (12%) and 21 (5%) of the 456 patients, respectively. Treatment included PCI in 191 (42%) and MTH in 188 (41%). Overall in-hospital and long-term (5-year) survival was 53% (n=240) and 44% (n=202), respectively. In the 170 patients treated with primary PCI, in-hospital survival was 112/170 (66%). After hospital discharge these patients had a 5-year survival rate of 99% and cerebral performance category was good in 92%.
  
  
  CONCLUSIONS
  In this integrated ST elevation myocardial infarction network survival and neurological outcome of selected patients with ROSC after OHCA and treated with PCI was good. There is insufficient evidence about the outcome of this approach, which has a significant impact on utilisation of resources. Good quality randomised controlled trials are needed. In selected patients successfully resuscitated after OHCA of presumed cardiac aetiology, we believe that a more liberal application of primary PCI may be considered in experienced acute cardiac referral centres.
authors.affiliation: Department of Critical Care, University Medical Center Groningen, The Netherlands Department of Anaesthesiology, University Medical Center Groningen, The Netherlands r.bergman@umcg.nl.
authors.forename: Remco
authors.initials: R
authors.lastname: Bergman
authors.affiliation: Department of Critical Care, University Medical Center Groningen, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Hiemstra
authors.affiliation: Department of Cardiology, University Medical Center Groningen, The Netherlands.
authors.forename: Wybe
authors.initials: W
authors.lastname: Nieuwland
authors.affiliation: Department of Cardiology, University Medical Center Groningen, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Lipsic
authors.affiliation: Department of Anaesthesiology, University Medical Center Groningen, The Netherlands.
authors.forename: Anthony
authors.initials: A
authors.lastname: Absalom
authors.affiliation: Department of Neurology, University Medical Center Groningen, The Netherlands.
authors.forename: Joukje
authors.initials: J
authors.lastname: van der Naalt
authors.affiliation: Department of Cardiology, Erasmus University Rotterdam, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.affiliation: Department of Critical Care, University Medical Center Groningen, The Netherlands.
authors.forename: Iwan Cc
authors.initials: IC
authors.lastname: van der Horst
authors.affiliation: Department of Critical Care, University Medical Center Groningen, The Netherlands.
authors.forename: Maarten Wn
authors.initials: MW
authors.lastname: Nijsten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006760:Hospitalization; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Out-of-hospital cardiac arrest; ST-elevation myocardial infarction; management; mild therapeutic hypothermia; percutaneous coronary intervention