title: Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol.
abstract: BACKGROUND
  In 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis-St. Paul.
  
  
  RESULTS
  Eleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and <76 and presumed cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07-3.72], P=0.03).
  
  
  CONCLUSIONS
  Early access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital discharge with a good neurological outcome.
authors.affiliation: Division of Cardiology, Department of Medicine, Minneapolis VA Healthcare System and University of Minnesota School of Medicine, Minneapolis, MN (S.G., S.A.).
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN (T.D., W.B., G.R., E.C., L.H., D.Y.).
authors.forename: Todd
authors.initials: T
authors.lastname: Drexel
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN (T.D., W.B., G.R., E.C., L.H., D.Y.).
authors.forename: Wobo
authors.initials: W
authors.lastname: Bekwelem
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN (T.D., W.B., G.R., E.C., L.H., D.Y.).
authors.forename: Ganesh
authors.initials: G
authors.lastname: Raveendran
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN (T.D., W.B., G.R., E.C., L.H., D.Y.).
authors.forename: Emily
authors.initials: E
authors.lastname: Caldwell
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN (T.D., W.B., G.R., E.C., L.H., D.Y.).
authors.forename: Lucinda
authors.initials: L
authors.lastname: Hodgson
authors.affiliation: Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN (Q.W.).
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Division of Cardiology, Department of Medicine, Minneapolis VA Healthcare System and University of Minnesota School of Medicine, Minneapolis, MN (S.G., S.A.).
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN (B.M.).
authors.forename: Brian
authors.initials: B
authors.lastname: Mahoney
authors.affiliation: Department of Emergency Medicine, Regions Hospital, St. Paul, MN (R.F.).
authors.forename: Ralph
authors.initials: R
authors.lastname: Frascone
authors.affiliation: Department of Cardiology, Fairview Southdale Medical Center, Minneapolis, MN (G.H.).
authors.forename: Gregory
authors.initials: G
authors.lastname: Helmer
authors.affiliation: Department of Emergency Medicine, Allina Medical Transportation, St. Paul, MN (C.L.).
authors.forename: Charles
authors.initials: C
authors.lastname: Lick
authors.affiliation: Department of Emergency Medicine, North Memorial Medical Center, Robbinsdale, MN (M.C.).
authors.forename: Marc
authors.initials: M
authors.lastname: Conterato
authors.affiliation: Department of Cardiology, United Hospital, St. Paul, MN (K.B.).
authors.forename: Kenneth
authors.initials: K
authors.lastname: Baran
authors.affiliation: Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN (B.B., F.B.).
authors.forename: Bradley
authors.initials: B
authors.lastname: Bart
authors.affiliation: Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN (B.B., F.B.).
authors.forename: Fouad
authors.initials: F
authors.lastname: Bachour
authors.affiliation: Department of Cardiology, North Memorial Medical Center, Robbinsdale, MN (S.R.).
authors.forename: Steven
authors.initials: S
authors.lastname: Roh
authors.affiliation: Division of Cardiology, Health East Hospital, St. Paul, MN (C.P.).
authors.forename: Carmelo
authors.initials: C
authors.lastname: Panetta
authors.affiliation: Division of Cardiology, Metropolitan Heart and Vascular Institute, Coon Rapids, MN (R.S.).
authors.forename: Randall
authors.initials: R
authors.lastname: Stark
authors.affiliation: Division of Cardiology, Park Nicollet Heart and Vascular Center, St. Louis Park, MN (M.H.).
authors.forename: Mark
authors.initials: M
authors.lastname: Haugland
authors.affiliation: Division of Cardiology, Abbott Northwestern Hospital, Minneapolis, MN (M.M.).
authors.forename: Michael
authors.initials: M
authors.lastname: Mooney
authors.affiliation: Health East Emergency Medical Services, St. Paul, MN (K.W.).
authors.forename: Keith
authors.initials: K
authors.lastname: Wesley
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN (T.D., W.B., G.R., E.C., L.H., D.Y.).
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D004554:Electric Countershock / Q000009:adverse effects / Q000401:mortality; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D009460:Neurologic Examination; D016017:Odds Ratio; D010351:Patient Discharge; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D015397:Program Evaluation; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D019037:Urban Health Services
keywords: cardiac arrest; cardiac catheterization; prognosis; revascularization