Abstract 10476: Patient Characteristics and Survival Outcomes of Cardiac Arrest in the Cardiac Catheterization Laboratory: Insights from Get with the Guidelines-Resuscitation Registry

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ahmed Elkaryoni ◽  
John J Lopez ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Catheterization ◽  
Odds Ratio ◽  
American Heart ◽  
Patient Characteristics ◽  
Lower Survival Rate ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: The characteristics and outcomes of in-hospital cardiac arrest (IHCA) in the cardiac catheterization laboratory (CCL) have not been well-described. We compared the characteristics and outcomes of patients with an IHCA in the CCL versus those in the operating room (OR) and the intensive care unit (ICU). Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation® registry, we identified patients 18 years of age or older with an IHCA in the CCL, OR, or ICU between 2000 and 2019. We compared rates of survival to discharge for patients in the CCL, OR, and ICU. Additionally, we examined predictors of survival to discharge for patients with IHCA in the CCL. Results: There were 6866, 5181, and 181,832 patients with an IHCA in the CCL, OR, and ICU, respectively. Patients with IHCAs in the CCL were more likely to have a shockable cardiac arrest rhythm as compared with those in the OR and ICU. Overall, 2614 (38.1%) patients with IHCA in the CCL survived to discharge, as compared with 30,833 (16.9%) from the ICU and 2096 (40.5%) from the OR. After adjustment for 27 patient and cardiac arrest factors, patients with IHCA in CCL were more likely to survive to discharge as compared with those with IHCA from the ICU (odds ratio, 1.37 [95% CI: 1.29-1.46], p<0.001). In contrast, they were less likely to survive to discharge as compared with those with IHCA in the OR (odds ratio, 0.81 [95% CI: 0.69-0.94], p=0.006). Predictors of survival to discharge in patients with IHCA in the CCL included white race, pulseless ventricular tachycardia/fibrillation, and IHCA during normal hours and on weekdays, while having myocardial infarction during this or prior hospitalization was associated with less survival to discharge. (Table). Conclusion: IHCA in the CCL is not uncommon and has a lower survival rate as compared with IHCA in other procedural areas such as the OR. The reasons for this difference deserve further study given that response to IHCAs in both settings should be similar.

Abstract 81: Early Access to Cardiac Catheterization Laboratory for Patients Resuscitated from Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol Two-Year Report

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Demetris Yannopoulos ◽  
Santiago Garcia ◽  
Brian Mahoney ◽  
Ralph J Frascone ◽  
Greg Helmer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Catheterization ◽  
Real Life ◽  
Inclusion Criteria ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Early Access ◽  
Shockable Rhythm ◽  
Surface Ecg ◽  
Gain Access

Background: Cardiac arrest patients that have been successfully resuscitated from shockable rhythms have a high prevalence of thrombotic and/or flow limiting coronary occlusion regardless of the presence of STEMI on the ECG. In 2012, the Minnesota Resuscitation Consortium (MRC) developed an organized approach for all those patients to gain early access to the cardiac catheterization laboratory (CCL). We report the two-year outcomes. Methods: Eleven metropolitan hospitals with 24/7 PCI capabilities agreed to provide early (within 2 hours of arrival to the emergency department) access to the CCL for all patients that were successfully resuscitated from VF/VT arrest regardless of the presence or absence of STEMI on the surface ECG. Inclusion criteria were: witnessed or un-witnessed, age >18 and <70, cardiac arrest of presumed cardiac etiology, comatose or conscious patients. Patients with PEA or asystole, known DNR/DNI, non-cardiac etiology, significant bleeding of any cause, terminal disease were excluded. Patient outcomes were recorded in the state database Cardiac Arrest Registry to Enhance Survival. Results: A total of 370 patients were resuscitated and met the inclusion criteria. Of those, 313 (85%) patients were taken to the CCL per protocol. The mean age was 55.5 years, 77% were men and 79% had witnessed arrest. Only 57 patients (15%) did not gain access to the CCL. Of the 313 patients that had early coronary angiography a total of 47% received primary angioplasty and had at least one vessel disease and 5% received coronary artery bypass. All comatose patients received therapeutic hypothermia and 35% received and implantable cardiac defibrillator. A total of 235/313 (75%) were discharged alive and of those 222/235 (94.5%) were discharged neurologically intact with a CPC of 1. Of the patients that did not gain access to the CCL, 46% (26/57) were discharged alive and of those 73% (19/26) had CPC of 1 [OR: 3.63; 2.03-6.5, p< 0.001]. Conclusions: Over the first two years of implementation, the MRC protocol for early access to the CCL in resuscitated patients from shockable rhythm was associated with 75% survival to hospital discharge and excellent neurological outcomes in a large metropolitan area and real-life clinical practice.

Cardiac Arrest in the Cardiac Catheterization Laboratory: Initial Experience With the Role of Simulation Setup and Training

2020 ◽  
pp. 106286062095080
Author(s):  
Omar Al-Mukhtar ◽  
Irma Bilgrami ◽  
Samer Noaman ◽  
Rebecca Lapsley ◽  
John Ozcan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Catheterization ◽  
Physical Environment ◽  
Improve Patient Care ◽  
Clinical Event ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Percutaneous Coronary ◽  
Specialized Equipment ◽  
Multidisciplinary Simulation

With rising complexity of percutaneous coronary interventions being performed, the incidence of cardiac arrest in the cardiac catheterization laboratory (CCL) is likely to increase. The authors undertook a series of multidisciplinary simulation sessions to identify practice deficiencies and propose solutions to improve patient care. Five simulation sessions were held at Western Health CCL to simulate different cardiac arrest scenarios. Participants included cardiologists, intensivists, anesthetists, nurses, and technicians. Post-simulation feedback was analyzed qualitatively. Challenges encountered were grouped into 4 areas: (1) communication and teamwork, (2) equipment, (3) vascular access and drugs, and (4) physical environment and radiation exposure. Proposed solutions included regular simulation training; increasing familiarity with the physical environment, utilization of specialized equipment; and formation of 2 team leaders to improve efficiency. Cardiac arrest in the CCL is a unique clinical event that necessitates specific training to improve technical and nontechnical skills with potential to improve clinical outcomes.

The Reinvention of the American Heart Association and the Invention of Cardiac Catheterization

2015 ◽  
Author(s):  
W. Bruce Fye
Keyword(s):  
World War Ii ◽  
Cardiac Catheterization ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Cardiovascular Research ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
National Heart ◽  
Health Organization

President Harry Truman signed the National Heart Act in 1948, which resulted in the creation of the National Heart Institute and started federal funds flowing to academic centers to support cardiovascular research. Mayo cardiologist Arlie Barnes’s term as president of the American Heart Association coincided with its transformation from a low-budget professional society into a large voluntary health organization that raised funds from the public to support its programs. World War II research into shock contributed to the development of cardiac catheterization as a clinical diagnostic tool. Mayo’s wartime research program that focused on ways to protect fighter pilots from blackouts due to high gravitational forces led to the invention of technologies to measure blood pressure and blood oxygen content. Physiologist Earl Wood used these tools in Mayo’s cardiac catheterization laboratory, which was established at the institution in 1947. The clinic helped pioneer the emerging field of cardiac catheterization.

scholarly journals In-Hospital Cardiac Arrest in the Cardiac Catheterization Laboratory: Effective Transition from an ICU- to CCU-Led Resuscitation Team

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Rajat Sharma ◽  
Hilary Bews ◽  
Hardeep Mahal ◽  
Chantal Y. Asselin ◽  
Megan O’Brien ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Catheterization ◽  
Tertiary Care ◽  
Pulseless Electrical Activity ◽  
Hospital Length Of Stay ◽  
Health Concern ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Coronary Syndrome ◽  
Code Blue

Objectives. (1) To examine the incidence and outcomes of in-hospital cardiac arrests (IHCAs) in a large unselected patient population who underwent coronary angiography at a single tertiary academic center and (2) to evaluate a transitional change in which the cardiologist is positioned as the cardiopulmonary resuscitation (CPR) leader in the cardiac catheterization laboratory (CCL) at our local tertiary care institution. Background. IHCA is a major public health concern with increased patient morbidity and mortality. A proportion of all IHCAs occurs in the CCL. Although in-hospital resuscitation teams are often led by an Intensive Care Unit- (ICU-) trained physician and house staff, little is known on the role of a cardiologist in this setting. Methods. Between 2012 and 2016, a single-center retrospective cohort study was performed examining 63 adult patients (70 ± 10 years, 60% males) who suffered from a cardiac arrest in the CCL. The ICU-led IHCAs included 19 patients, and the Coronary Care Unit- (CCU-) led IHCAs included 44 patients. Results. Acute coronary syndrome accounted for more than 50% of cardiac arrests in the CCL. Pulseless electrical activity was the most common rhythm requiring chest compression, and cardiogenic shock most frequently initiated a code blue response. No significant differences were observed between the ICU-led and CCU-led cardiac arrests in terms of hospital length of stay and 1-year survival rate. Conclusion. In the evolving field of Critical Care Cardiology, the transition from an ICU-led to a CCU-lead code blue team in the CCL setting may lead to similar short-term and long-term outcomes.

scholarly journals Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest

2019 ◽  
Vol 130 (3) ◽  
pp. 414-422 ◽  
Author(s):  
Nicholas G. Bircher ◽  
Paul S. Chan ◽  
Yan Xu ◽  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Epinephrine Administration ◽  
Time To Initiation ◽  
Adjusted Logistic Regression ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest ◽  
Index Cases

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Because the extent to which delays in initiating cardiopulmonary resuscitation (CPR) versus the time from CPR to defibrillation or epinephrine treatment affects survival remains unknown, it was hypothesized that all three independently decrease survival in in-hospital cardiac arrest. Methods Witnessed, index cases of cardiac arrest from the Get With The Guidelines–Resuscitation Database occurring between 2000 and 2008 in 538 hospitals were included in this analysis. Multivariable risk-adjusted logistic regression examined the association of time to initiation of CPR and time from CPR to either epinephrine treatment or defibrillation with survival to discharge. Results In the overall cohort of 57,312 patients, there were 9,802 survivors (17.1%). Times to initiation of CPR greater than 2 min were associated with a survival of 14.7% (91 of 618) as compared with 17.1% (9,711 of 56,694) if CPR was begun in 2 min or less (adjusted odds ratio [95% CI], 0.68 [0.54 to 0.87]; P &lt; 0.002). Times from CPR to either defibrillation or epinephrine treatment of 2 min or less were associated with a survival of 18.0% (7,654 of 42,475), as compared with 15.0% (1,680 of 11,227) for 3 to 5 min (reference, 0 to 2 min; adjusted odds ratios [95% CI], 0.83 [0.78 to 0.88]; P &lt; 0.001), 12.8% (382 of 2,983) for 6 to 8 min (0.67 [0.60 to 0.76], P &lt; 0.001), and 13.7% (86 of 627) for 9 to 11 min (0.54 [0.42 to 0.69], P &lt; 0.001). Conclusions Delays in the initiation of CPR and from CPR to defibrillation or epinephrine treatment were each associated with lower survival.

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