Elsevier

American Heart Journal

Volume 164, Issue 4, October 2012, Pages 493-501.e2
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Regionalization of post–cardiac arrest care: Implementation of a cardiac resuscitation center

https://doi.org/10.1016/j.ahj.2012.06.014Get rights and content

Background

Guidelines recommend standardized treatment of post–cardiac arrest patients to improve outcomes. However, the infrastructure, resources, and personnel required to meet the complex needs of cardiac arrest victims remain a barrier to care. Given that regionalization of time-dependent high-acuity illness is an emerging paradigm, the aim of the present study was to develop and implement a regionalized approach to post–cardiac arrest care.

Methods

We performed a prospective observational study on all patients treated in a regionalized clinical pathway from November 2007 through June 2011. All patients were enrolled after admission to an urban academic medical center. Clinical data including arrest and treatment variables, complications, and outcome were collected on consecutive patients with the use of a preformatted standard data collection tool using Utstein criteria.

Results

A total of 220 patients were enrolled; 127 (58%) patients were local direct admissions from our community, and 93 (42%) were transferred from 1 of 24 outlying referral hospitals. One hundred six (48%, 95% CI 38%-53%) patients survived to hospital discharge. The primary outcome of hospital survival with good neurologic function was observed in 94 (43%, 95% CI 32%-48%). There was no difference in survival with good neurologic outcome among local and referred patients. Overall 1-year survival was 44% (95% CI 38%-51%). Among patients discharged from the hospital with good neurologic function, 93% (95% CI 85%-97%) remained alive at 1 year.

Conclusion

Development of a regionalized approach to post–cardiac arrest care using previously established referral relationships is feasible, and implementation of such an approach was clinically effective in our region.

Section snippets

Study design and setting

We performed a prospective observational study on all patients treated in our clinical pathway from November 2007 through June 2011. All patients were enrolled after admission to Carolinas Medical Center, an urban 900-bed teaching hospital. Our center is an STEMI-receiving hospital as designated by the American Heart Association Mission: Lifeline regional systems of care program and is accredited by the Society of Chest Pain Centers. This hospital is also the tertiary care medical center of

Results

An alert page was activated for 248 patients, of which 26 patients were deemed ineligible. Moribund cardiovascular status (n = 13), neurologic improvement (n = 6), advanced comorbid disease, and directives status (n = 4) were the most common reasons for patient ineligibility. Overall, 222 patients were formally entered into the treatment pathway during the study period. Two patients were excluded from analysis due to incomplete data, leaving 220 patients for analysis. Demographics, comorbid

Discussion

We report our initial experience in developing and implementing a regional cardiac resuscitation center. Our primary outcome measure of survival with good neurologic outcome is comparable with the landmark investigational studies and subsequent observational experiences supporting use of therapeutic hypothermia for comatose victims of cardiac arrest.29, 30 This confirms the feasibility and clinical effectiveness of our treatment strategy to develop a regionalized approach to post–cardiac arrest

Conclusions

A regionalized approach to post–cardiac arrest care based on a referral cardiac resuscitation center is feasible and effective. Established referral relationships for other high-acuity diseases such as STEMI, trauma, and stroke serve as a proposed model for immediate regionalization of post–cardiac arrest care. Recognizing the brief therapeutic window to impact the post–cardiac arrest syndrome, efforts to initiate best practice before and during interfacility transport should be prioritized.

Disclosures

Relationship with industry disclosure: Alan Heffner, MD, has received honoraria for educational lectures on the topic of therapeutic hypothermia from Medivance, Inc.

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