An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA)

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre. This study aimed to compare the short-term mortality of patients admitted with an OHCA before-and-after the merger of services had taken place and admission criteria were relaxed, which led to managing OHCA in higher volume. Methods: We retrospectively analysed the data of OHCA patients pre- and post-merger. Baseline demographic and medical characteristics were recorded, along with factors relating to the cardiac arrest. The primary endpoint was in-hospital mortality. Results: OHCA patients ( N =728; 267 pre- and 461 post-merger) between 2013 and 2018 were analysed. Patients admitted pre-merger were older (65.0 vs. 62.4 years, p=0.027), otherwise there were similar baseline demographic and peri-arrest characteristics. There was a greater proportion of non-acute coronary syndrome-related OHCA admission post-merger (10.1% vs. 23.4%, p=0.0001) and a corresponding decrease in those admitted with ST-elevation myocardial infarction (80.2% vs. 57.0%, p=0.0001) and those treated with percutaneous coronary intervention (78.8% vs. 54.0%, p=0.0001). Despite this, in-hospital mortality was lower post-merger (63.7% vs. 44.3%, p=0.0001), which persisted after adjustment for demographic and arrest-related characteristics using stepwise logistic regression ( p=0.036) between the groups. Conclusion: Despite an increase in non-acute coronary syndrome-related OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit of a cardiac arrest centre model of care.

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P2665An observational study assessing the impact of a cardiac arrest centre on patient outcome

European Heart Journal ◽

10.1093/eurheartj/ehz748.0984 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T N Jones ◽

M D Kelham ◽

K S Rathod ◽

O Guttmann ◽

A Proudfoot ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

The United States ◽

Demographic Characteristics ◽

Admission Criteria ◽

Before And After ◽

Cardiac Centre ◽

The Impact ◽

Hospital Cardiac Arrest ◽

Baseline Demographic

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a major cause of death in Europe and the United States. There has been recent literature to suggest that the centralisation of OHCA services may benefit patient outcomes. In 2015, two major tertiary cardiac centres in the UK agglomerated to form a large dedicated tertiary cardiac centre. The previous centre had strict criteria on which OHCA patients could be admitted, with the vast majority of cases being STEMI-related. After the agglomeration, admission criteria were relaxed to include all OHCA cases within geographic range with a suspected cardiac cause. Purpose This study aimed to compare the short-term mortality of patients admitted with an OHCA to a tertiary cardiac centre before-and-after a major agglomeration of services had taken place and admission criteria had been relaxed. Methods We retrospectively analysed the data of patients admitted before and after agglomeration (2015) with OHCA who were resuscitated via conventional cardiopulmonary resuscitation. Baseline demographic characteristics were recorded, along with factors relating to the cardiac arrest. Primary endpoint was in-hospital mortality. Results A total of 650 patients (189 before and 461 after the agglomeration) with an OHCA between 2013 and 2018 were analysed. Patients admitted pre merger were older (67.7 vs 62.4 years, p=0.022), otherwise there were similar baseline demographic characteristics between patients admitted before and after the agglomeration (pre vs post) in terms of gender (74.4% vs 75.9% male, p=0.827), ethnicity (66.7% vs 58.9% Caucasian, p=0.588) and existing coronary artery disease (22.8% vs 22.7%, p=0.432). There were also similar peri-arrest characteristics, with a comparable number of patients having a non-shockable rhythm (15.4% vs 25.4%, p=0.164) and similar total downtimes between the groups (33 vs 32.3 mins, p=0.883). Interestingly there was a decrease in those with cardiogenic shock on arrival (92.3% vs 57.0%, p=0.0001) and fewer patients with an ejection fraction <30% (63.2 vs 38.7%, p=0.0003) post-agglomeration. There was a greater proportion of non-ACS-related OHCA admission after the agglomeration (16.9% vs 24.1%, p=0.047) and a corresponding decrease in those admitted with a STEMI (81.5% vs 62.3%, p=0.032) and those treated with PCI (77.8% vs 54.0%, p=0.034). Despite this, in-hospital mortality was lower after the agglomeration (69.7% vs 47.1%, p=0.019), which persisted after adjustment for the previously described demographic and arrest-related characteristics using stepwise logistic regression (p=0.036) between the two groups. Conclusion Despite an increase in non-ACS-related-OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit for an out-of-hospital cardiac arrest-centre model of care, supporting a centralised strategy for immediate post-resuscitation care in OHCA patients. Acknowledgement/Funding None

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Percutaneous Coronary Intervention Reduces Mortality in Out-of-Hospital Cardiac Arrest after Acute Coronary Syndrome: An Outcomes-Based Study from the Nationwide Inpatient Sample Database

Surgical Science ◽

10.4236/ss.2017.81004 ◽

2017 ◽

Vol 08 (01) ◽

pp. 27-36

Author(s):

Christine S. M. Lau ◽

Mahyar Pourriahi ◽

Amanda Ward ◽

Kedar P. Kulkarni ◽

Krishnaraj Mahendraraj ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Nationwide Inpatient Sample ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Nationwide Inpatient Sample Database ◽

Percutaneous Coronary ◽

Hospital Cardiac Arrest

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The effect of the COVID-19 pandemic on acute coronary syndrome hospitalizations and out-of-hospital cardiac arrest in Greece

Public Health ◽

10.1016/j.puhe.2020.12.006 ◽

2020 ◽

Author(s):

Chris J. .Kapelios ◽

Christos Siafarikas ◽

Maria Bonou ◽

Stavros Liatis ◽

John Barbetseas

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Arrest ◽

Coronary Syndrome ◽

Hospital Cardiac Arrest

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Abstract 11324: Immediate Percutaneous Coronary Intervention in Patients with Refractory Out of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.11324 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Daniel Rob ◽

Jana Smalcova ◽

Tomas Kovarnik ◽

David Zemanek ◽

Ales Kral ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Cardiac Arrest ◽

Lower Risk ◽

Coronary Intervention ◽

Post Hoc Analysis ◽

Risk Of Death ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Post Hoc ◽

Hospital Cardiac Arrest

Background: An increasing number of cardiac centres are using immediate percutaneous coronary intervention (PCI) and extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out of hospital cardiac arrest (r-OHCA). Published evidence regarding PCI in OHCA has been mainly reporting to patients with early return of spontaneous circulation and the influence of PCI and ECPR on survival in the population of patients with r-OHCA and acute coronary syndrome (ACS) remains unclear. Methods: In this post hoc analysis of the randomized r-OHCA trial, all patients with ACS as a cause of r-OHCA were included. The effect of successful PCI and ECPR on 180-days survival was examined using Kaplan-Meier estimates and multivariable Cox regression. Results: In total, 256 patients were evaluated in Prague OHCA study and 127 (49.6 %) had ACS as the cause of r-OHCA constituting current study population. The mean age was 58 years (46.3-64) and duration of resuscitation was 52.5 minutes (36.5-68). ECPR was used in 51 (40.2 %) of patients. Immediate PCI was performed in 86 (67.7%) patients and TIMI flow 2 or 3 was achieved in 75 (87.2%) patients. The overall 180-days survival of patients with successful PCI was 40 % compared to 7.7 % with no or failed immediate PCI (log-rank p < 0.001). After adjustment for confounders, successful PCI was associated with a lower risk of death (HR 0.47, CI 0.24-0.93, p = 0.031). Likewise, ECPR was associated with a lower risk of death (HR 0.11, CI 0.05-0.24, p< 0.001). Conclusion: In this post hoc analysis of the randomized r-OHCA trial, successful immediate PCI as well as ECPR were associated with improved 180-days survival in patients with r-OHCA due to ACS.

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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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