Journal
RESUSCITATION
Volume 73, Issue 1, Pages 29-39Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2006.08.016
Keywords
heart arrest; cardiopulmonary resuscitation; therapeutic hypothermia; angioplasty; survival
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Background: Mortality among patients admitted to hospital after out-of-hospital cardiac arrest (OHCA) is high. Based on recent scientific evidence with a main goat of improving survival, we introduced and implemented a standardised post resuscitation protocol focusing on vital. organ function including therapeutic hypothermia, percutaneous coronary intervention (PCI), control of haemodynamics, blood glucose, ventilation and seizures. Methods: ALL patients with OHCA of cardiac aetiology admitted to the ICU from September 2003 to May 2005 (intervention period) were included in a prospective, observational study and compared to controls from February 1996 to February 1998. Results: In the control period 15/58 (26%) survived to hospital discharge with a favourable neurological outcome versus 34 of 61 (56%) in the intervention period (OR 3.61, CI 1.66-7.84, p = 0.001). All survivors with a favourable neurological outcome in both groups were still alive 1 year after discharge. Two patients from the control period were revascularised with thrombolytics versus 30 (49%) receiving PCI treatment in the intervention period (47 patients (77%) underwent cardiac angiography). Therapeutic hypothermia was not used in the control period, but 40 of 52 (77%) comatose patients received this treatment in the intervention period. Conclusions: Discharge rate from hospital, neurological outcome and 1-year survival improved after standardisation of post resuscitation care. Based on a multivariate logistic analysis, hospital treatment in the intervention period was the most important independent predictor of survival. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
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