Prevalence and outcomes of out-of-hospital cardiac arrest survivors with left main or triple vessel coronary diseases: A multi-center, retrospective cohort study

Abstract Background While multivessel coronary artery disease (CAD) is frequently observed in out-of-hospital cardiac arrest (OHCA) survivors, little is known about the impact of revascularization strategy on outcomes. We aimed to evaluate the prevalence of left main or triple vessel CAD in comatose survivors of OHCA and assess their outcome based on the revascularization strategy. Methods This multicenter retrospective cohort study was conducted at 9 Korean tertiary care hospitals. Adult comatose OHCA survivors with left main or triple vessel CAD documented by immediate (≤ 2 hours) coronary angiography after return of spontaneous circulation between 2011 and 2019 were included. The primary outcome was neurologically intact survival at 1-month defined as survival with a Cerebral Performance Category score of 1–2. Results Among 727 OHCA patients with immediate coronary angiography, 150 (25.3%) with left main or triple vessel CAD were identified and categorized into complete (N = 32), incomplete (N = 78), and no immediate (N = 40) revascularization groups. The rate of neurologically intact survival at 1 month was significantly different among the groups (53.1%, 32.1%, and 22.5% for complete, incomplete, and no immediate revascularization groups, respectively; P = 0.021). After adjustment using the inverse probability of treatment weighting, complete revascularization was independently associated with neurologically intact survival at 1 month (odds ratio, 2.635; 95% confidence interval, 1.128–6.155; P = 0.012). Conclusions Left main or triple vessel CAD is not uncommon in comatose OHCA patients. The rate of neurologically intact survival at 1 month was 34.0%, and it was significantly greater in patients with complete revascularization than in patients with incomplete or no immediate revascularization. Further clinical trials will be needed to confirm the best revascularization strategy to improve outcomes in such critically ill patients.

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Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19005077 ◽

2019 ◽

Vol 35 (1) ◽

pp. 17-23

Author(s):

Julian G. Mapp ◽

Anthony M. Darrington ◽

Stephen A. Harper ◽

Chetan U. Kharod ◽

David A. Miramontes ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Hospital Discharge ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

San Antonio ◽

Cerebral Performance Category ◽

Published Data ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

AbstractIntroduction:To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.Methods:This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).Results:Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).Conclusion:This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.

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