title: The Postcardiac Arrest Consult Team: Impact on Hospital Care Processes for Out-of-Hospital Cardiac Arrest Patients.
abstract: OBJECTIVE
  To evaluate whether a Post-Arrest Consult Team improved care and outcomes for patients with out-of-hospital cardiac arrest.
  
  
  METHODS
  Prospective cohort study of Post-Arrest Consult Team implementation at two hospitals, with concurrent controls from 27 others.
  
  
  METHODS
  Twenty-nine hospitals within the Strategies for Post-Arrest Care Network of Southern Ontario, Canada.
  
  
  METHODS
  We included comatose adult nontraumatic out-of-hospital cardiac arrest patients surviving more than or equal to 6 hours after emergency department arrival who had no contraindications to targeted temperature management.
  
  
  METHODS
  The Post-Arrest Consult Team was an advisory consult service to improve 1) targeted temperature management, 2) assessment for percutaneous coronary intervention, 3) electrophysiology assessment, and 4) appropriately delayed neuroprognostication.
  
  
  RESULTS
  We used generalized linear mixed models to explore the association between Post-Arrest Consult Team implementation and performance of targeted processes. We included 1,006 patients. The Post-Arrest Consult Team was associated with a significant reduction over time in rates of withdrawal of life-sustaining therapy within 72 hours of emergency department arrival on the basis of predictions of poor neurologic prognosis (ratio of odds ratios, 0.13; 95% CI, 0.02-0.98). Post-Arrest Consult Team was not associated with improved successful targeted temperature management (ratio of odds ratios, 0.91; 95% CI, 0.31-2.65), undergoing angiography (ratio of odds ratios, 1.91; 95% CI, 0.17-21.04), receiving electrophysiology consultation (ratio of odds ratios, 0.93; 95% CI, 0.11-8.16), or functional survival (ratio of odds ratios, 0.75; 95% CI, 0.19-2.94).
  
  
  CONCLUSIONS
  Implementation of a Post-Arrest Consult Team reduced premature withdrawal of life-sustaining therapy but did not improve rates of successful targeted temperature management, coronary angiography, formal electrophysiology assessments, or functional survival for comatose patients after out-of-hospital cardiac arrest.
authors: 1Department of Emergency Medicine, Queen's University, Kingston, ON, Canada. 2Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario Canada. 3Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 4Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON. 6Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada. 7Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada. 8Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. 9Heart and Vascular Program, St. Michael's Hospital, Toronto, ON, Canada. 10Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada. 11Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada. 12Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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mesh_terms: D026683:Advisory Committees; D000368:Aged; D001831:Body Temperature / Q000502:physiology; D001921:Brain / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D003128:Coma / Q000209:etiology / Q000628:therapy*; D017023:Coronary Angiography; D003422:Critical Care / Q000379:methods*; D017147:Defibrillators, Implantable; D003952:Diagnostic Imaging; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012017:Referral and Consultation; D028761:Withholding Treatment / Q000706:statistics & numerical data