Clinical InvestigationAcute Ischemic Heart DiseaseRegionalization of post–cardiac arrest care: Implementation of a cardiac resuscitation center
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.
References (39)
- et al.
Neurological rehabilitation of severely disabled cardiac arrest survivors. Part I. Course of post-acute inpatient treatment
Resuscitation
(2000) - et al.
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke
Resuscitation
(2008) - et al.
Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest
Resuscitation
(2009) - et al.
Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey
Resuscitation
(2005) - et al.
Inter-hospital variability in post-cardiac arrest mortality
Resuscitation
(2009) - et al.
Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks
Am Heart J
(2006) - et al.
A regional system of stroke care provides thrombolytic outcomes comparable with the NINDS stroke trial
Ann Emerg Med
(2009) Pro/Con debate: cardiac arrest survivors need proof of neurological function before percutaneous coronary intervention
Crit Care Resusc
(2007)- et al.
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction)
J Am Coll Cardiol
(2004) - et al.
The association between intra-arrest therapeutic hypothermia and return of spontaneous circulation among individuals experiencing out of hospital cardiac arrest
Resuscitation
(2011)
Induced hypothermia and fever control for prevention and treatment of neurological injuries
Lancet
Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms
Resuscitation
Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: a systematic review and meta-analysis of randomized and non-randomized studies
Resuscitation
Sudden cardiac death in the United States, 1989 to 1998
Circulation
Regional variation in out-of-hospital cardiac arrest incidence and outcome
JAMA
Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis
Circ Cardiovasc Qual Outcomes
Neurological rehabilitation of severely disabled cardiac arrest survivors
Part II. Life situation of patients and families after treatment. Resuscitation
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia
N Engl J Med
Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest
N Engl J Med
Cited by (37)
Predictors of hospital transfer and associated risks of mortality in acute pancreatitis
2021, PancreatologyCitation Excerpt :In a recent propensity-matched cohort study evaluating inter-hospital transfers and clinical outcomes for Medicare patients, among disease categories, higher propensity-matched odds of mortality were observed for gastrointestinal disease, specifically gastrointestinal bleeding [13]. While our findings show that patients transferred with AP have worse outcomes, other conditions such as acute myocardial infarction or stroke actually tend to do better when they are transferred to tertiary care centers [14–17]. Proposed explanations for these improved outcomes include standardized transfer protocols and timeliness of intended interventions for patients with these conditions [13].
Patterns of Care and Clinical Outcomes in Patients with Cerebral Sinus Venous Thrombosis
2020, Journal of Stroke and Cerebrovascular DiseasesLong-Term Survival Trends of Medicare Patients After In-Hospital Cardiac Arrest: Insights from Get With The Guidelines-Resuscitation<sup>®</sup>
2018, ResuscitationCitation Excerpt :Using data from a large, national, contemporary registry linked with Medicare claims files, we evaluated temporal trends of 30-day and 1-year survival among Medicare beneficiaries with IHCA. Due to the changing epidemiology of in-hospital cardiac arrest with a declining proportion of arrests due to shockable rhythms (ventricular fibrillation [VF] and pulseless ventricular tachycardia [VT]), we also evaluated temporal trends of 1-year survival by initial cardiac-arrest rhythm [3,4]. The Get With The Guidelines®-Resuscitation (GWTG-R) Registry is a large, contemporary, quality-improvement registry of in-hospital cardiac arrests.