Coronary artery diseaseUsefulness of Cooling and Coronary Catheterization to Improve Survival in Out-of-Hospital Cardiac Arrest
Section snippets
Methods
Melbourne has approximately 3.9 million inhabitants, which is served by a comprehensive centrally co-ordinated ambulance system, which is described elsewhere.1 The Alfred Hospital (Melbourne, Victoria, Australia) is a large tertiary-/quaternary-care referral center that provides 24-hour emergency coronary and cardiac surgical interventions for patients with acute coronary syndromes.
In this retrospective analysis we evaluated clinical characteristics and outcomes of all patients who had an
Results
Baseline characteristics of the study population are presented in Table 1. Important prehospital factors including rates of witnessed cardiac arrest, bystander cardiopulmonary resuscitation, time until ROSC, and adrenaline administration by paramedics were similar in the control and contemporary cohorts. On arrival to the emergency department the incidence of cardiogenic shock, defined as systolic blood pressure <90 mm Hg or requiring inotropic support, did not differ significantly between
Discussion
This study has demonstrated that a contemporary treatment paradigm with focused co-ordinated postresuscitative care combining therapeutic hypothermia with coronary angiography is associated with significant improvements in short-term clinical outcomes. The 64% survival to discharge rate is significantly better than other registry data of patients with OHCA and favorably compares to other institutions with similar treatment protocols.7, 8
In the contemporary treatment group, 98% of comatose
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Cited by (63)
Substantial Variation Exists in Post-Cardiac Arrest Outcomes Across Michigan Hospitals
2021, ResuscitationCitation Excerpt :However, there has not been the same broad focus on improving outcomes for subjects who survive to hospital admission. Left heart catheterization (LHC) and targeted temperature management (TTM) are post OHCA interventions which may improve outcome, but there has been little work exploring variability in their provision by hospitals and its association on survival6–12. In the United States, 347,322 adults sustain EMS-assessed non-traumatic OHCA annually13.
Variation in outcomes among 24/7 percutaneous coronary intervention centres for patients resuscitated from out-of-hospital cardiac arrest
2019, ResuscitationCitation Excerpt :While cardiac catheterisation and PCI may directly cause this increase in favourable outcomes by restoring coronary flow in patients with critical coronary lesions,23,26 they may also be a surrogate marker for more aggressive post-arrest care. Other post-arrest interventions associated with improved outcomes in patients resuscitated from OHCA include targeted temperature management,16,25 seizure detection,27 and avoidance of hyperoxia.28 Availability and implementation of these interventions may also vary between 24/7 PCI centres.
Outcomes of ST Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest (from the Los Angeles County Regional System)
2017, American Journal of CardiologyProphylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest—A randomized pilot study
2017, ResuscitationCitation Excerpt :During the last decade, postresuscitation management of comatose survivors of out-of-hospital cardiac arrest (OHCA) significantly improved and “bundle of care” including therapeutic hypothermia, immediate coronary angiography, percutaneous coronary intervention (PCI) and contemporary intensive care nowadays leads to survival with good neurological recovery in ≥50% of patients with initial shockable rhythm who are hospitalized after reestablishment of spontaneous circulation (ROSC).1–4
Dr. Stub is supported by a scholarship from the Cardiac Society of Australia & New Zealand, Sydney, NSW and an award from Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.