Abstract 18554: Patient, Cardiac Arrest and Hospital Characteristics That Predict Receipt of Coronary Angiography in Out-of-Hospital Cardiac Arrest Patients

Introduction: Previous studies have suggested an association between coronary angiography and improved outcomes amongst post cardiac arrest patients. Our objective was to measure the association between patient and hospital-level characteristics and receipt of coronary angiography to generate hypotheses to inform a definitive trial. Methods: This was a population-based retrospective cohort study of data from 28 hospitals in Southern Ontario between March 1, 2010 and December 31, 2014. We included consecutive adult patients with atraumatic, OHCA, who achieved return of spontaneous circulation, and were alive 6 hours after hospital arrival. Multi-level logistic regression was used to measure the relationship between patient and hospital-level covariates and receipt of coronary angiography, adjusted for clustering and potential confounders. Results: During the period of study, 2678 consecutive patients met the inclusion criteria; mean age 66(±16), 68.3% male, 45.9% shockable initial rhythm, 84.2% comatose at hospital admission. Overall, 32.4% received coronary angiography and 21.8% received percutaneous coronary intervention (PCI). Coronary angiography use varied from 12.7% to 63.6% across the sites. Factors significantly associated with receiving coronary angiography included ST-elevation (OR=23.31, CI95 17.64-30.80), being comatose at hospital arrival (OR=0.15, CI95 0.10-0.23), shockable initial cardiac rhythm (OR=4.87, CI95 3.70-6.41), bystander AED use (OR=2.05, CI95 1.21-3.47), EMS-witnessed arrest (OR=1.80, CI95 1.16-2.78), initiation of therapeutic hypothermia (OR=1.96, CI95 1.38-2.79), initial admission to a PCI centre (OR=3.20, CI95 1.78-5.76), male sex (OR=1.43, CI95 1.07-1.90) and age (OR=0.98, CI95 0.97-0.99). Conclusions: There is significant variability in receipt of coronary angiography after cardiac arrest. We identified several patient and hospital-level factors that contribute to this variability. Future work should determine which post arrest patients will benefit most from urgent angiography and develop and evaluate knowledge translation strategies to ensure consistent delivery of best practices.

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Abstract 18724: Coronary Angiography After Out-of-hospital Cardiac Arrest is Associated With Improved Neurologically Intact Survival

Circulation ◽

10.1161/circ.132.suppl_3.18724 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tasha Hanuschak ◽

Steven Brooks ◽

Laurie Morrison ◽

Paul Peng ◽

Cathy Zhan

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Population Based ◽

Spontaneous Circulation ◽

Hospital Arrival ◽

Hospital Size ◽

Return Of Spontaneous Circulation ◽

Randomized Controlled Studies ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Introduction: Evidence for the effectiveness of coronary angiography after out-of-hospital cardiac arrest (OHCA) is conflicting. Our objective was to evaluate the association between receiving coronary angiography within 72 hours of hospital arrival and survival with favorable neurologic outcome. Methods: This was a population-based retrospective cohort study of consecutive cases of adult OHCA transported to and treated at 28 hospitals in Southern Ontario between March 1, 2010 and December 31, 2014. We included patients with atraumatic OHCA, who achieved return of spontaneous circulation, and were alive 6 hours after hospital arrival. Multi-level logistic regression was used to measure the association between early coronary angiography and neurologically intact survival (Modified Rankin Score 0-2), while controlling for potential confounders and clustered data. We controlled for age, sex, initial cardiac rhythm, witness status, bystander resuscitation, EMS response time, prehospital return of spontaneous circulation, location of arrest, daytime presentation, neurologic status at hospital arrival, STEMI status, cardiac history, initiation of therapeutic hypothermia, hospital size and type, and hospital annual cardiac arrest volume. Results: During the period of study, 2678 consecutive OHCA patients met the inclusion criteria. The mean age was 66(±16), 31.7% were female, 54.1% had a bystander witnessed arrest, 35.2% received bystander CPR, 45.9% had a shockable initial rhythm, 30.1% had ST elevation on the first post arrest ECG, and 32.4% received coronary angiography. Receiving coronary angiography was strongly associated with neurologically intact survival (OR 2.30, CI95 1.69-3.15) and survival (OR 2.08, CI95 1.53-2.82). A similar association was observed in the subgroup of patients without STEMI (OR 3.24, CI95 2.16-4.87 and OR 2.66, CI95 1.78-3.99, respectively). Conclusions: Neurologically intact survival among post cardiac arrest patients may be improved with coronary angiography, particularly for patients without STEMI. This observation should be confirmed with future randomized controlled studies.

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Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2021.03.028 ◽

2021 ◽

Vol 60 (4) ◽

pp. 580-581

Author(s):

Vivian Diep ◽

Nhan “Marc” Phan

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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Intraosseous administration of hydroxocobalamin after enclosed structure fire cardiac arrest

BMJ Case Reports ◽

10.1136/bcr-2020-239523 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239523

Author(s):

Joshua Mastenbrook ◽

Rachel Zamihovsky ◽

Nathan Brunken ◽

Thomas Olsen

Keyword(s):

Cardiac Arrest ◽

Circulatory System ◽

Neurological Status ◽

Human Case ◽

Spontaneous Circulation ◽

Smoke Inhalation ◽

Cyanide Poisoning ◽

Hospital Arrival ◽

Marrow Cavity ◽

Developed World

Smoke inhalation is the most common cause of acute cyanide poisoning in the developed world. Hydroxocobalamin is an antidote for cyanide poisoning. There is little published about human intraosseous antidote administration. We present a case of intraosseous hydroxocobalamin administration in an adult smoke inhalation victim, found in cardiac arrest inside her burning manufactured home. Return of spontaneous circulation was achieved after 20 min of cardiopulmonary resuscitation. Five grams of hydroxocobalamin were subsequently given intraosseously. On hospital arrival, patient was found to have a respiratory-metabolic acidosis. She had red-coloured urine without haematuria, a known sequela of hydroxocobalamin administration. Patient’s neurological status deteriorated, and she died 4 days after admission. This case highlights that intraosseously administered hydroxocobalamin seems to adequately flow into the marrow cavity and enter the circulatory system despite the non-compressible glass antidote vial. This appears to be only the second reported human case of intraosseous hydroxocobalamin administration.

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Abstract 11372: A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.144.suppl_2.11372 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Andy T Tran ◽

Anthony Hart ◽

John Spertus ◽

Philip Jones ◽

Bryan McNally ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Risk Adjustment ◽

Quality Measures ◽

Coronary Intervention ◽

Spontaneous Circulation ◽

Logistic Regression Models ◽

Adjustment Model ◽

Risk Adjustment Model ◽

Hospital Cardiac Arrest

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

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TCT-118 Sex Differences in Coronary Angiography, Percutaneous Coronary Intervention, and Outcomes During Hospitalization After Out of Hospital Cardiac Arrest with Ventricular Fibrillation or Pulseless Ventricular Tachycardia

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.09.024 ◽

2016 ◽

Vol 68 (18) ◽

pp. B47-B48

Author(s):

Nileshkumar Patel ◽

Nish Patel ◽

Shilpkumar Arora ◽

Apurva Badheka ◽

Abhishek Deshmukh ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Sex Differences ◽

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Coronary Angiography ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

Hospital Cardiac Arrest

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Abstract 18207: Role of Coronary Angiography with Successful Percutaneous Coronary Intervention in Patients with Out-of-Hospital Cardiac Arrest without ST-Segment Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.18207 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Yader Sandoval ◽

David F Miranda ◽

Steven R Goldsmith ◽

Bradley A Bart ◽

Stephen W Smith ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Coronary Angiography ◽

Coronary Intervention ◽

St Segment Elevation ◽

St Segment ◽

Percutaneous Coronary ◽

The Impact ◽

Referral Bias ◽

Hospital Cardiac Arrest

Background: Emerging data have supported a strategy of earlier access to cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA). However, there are as yet no randomized controlled trials (RCT) addressing the issue, and the impact of percutaneous coronary intervention (PCI) on outcome is unclear in the absence of STEMI. We report here the characteristics and outcomes of patients with OHCA without STEMI undergoing coronary angiography (CA) with PCI vs. no PCI, in contrast to patients not undergoing CA. Methods: Single center, retrospective study of 195 patients with OHCA without STEMI between July 2007 and April 2014. Patients were categorized into CA vs. no CA (control), and among those undergoing CA we compared those treated with PCI vs. no PCI. Mortality was assessed along with key relevant clinical and angiographic variables in each group (Table). Results: 195 cases with OHCA without STEMI were reviewed, among which 102 (52%) did not undergo CA. 93 (48%) patients underwent CA, of which 21 (23%) underwent PCI, whereas 72 (77%) did not require PCI. Acute culprit lesion was identified in only 19 out of 93 (20.4%) Inpatient mortality was similar in those undergoing PCI vs. no PCI (19% vs. 14%, p=0.56). Patients that did not undergo CA had a significantly worse mortality, in comparison to patients undergoing CA (p<0.001). Conclusions: In this series of consecutive patients with OHCA without STEMI, culprit lesions were uncommon when CA was performed. Overall outcomes in patients receiving CA were better than in those not receiving CA, likely reflecting referral bias based on disease severity. However, successful PCI in patients with obstructive CAD and culprit lesions was not associated with improved inpatient survival. These findings emphasize the need for RCTs to guide the need for CA and/or PCI in these patients.

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