Introduction and Hypothesis:
Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after OHCA receive induced hypothermia at equal rates and equally prompt during day- and night, as well as potential differences in neurologic outcomes.
Methods:
We retrospectively analyzed data of non-traumatic OHCA patients who regained restoration of spontaneous circulation (ROSC) and were admitted to our emergency department with an integrated intensive care unit (resuscitation center) at a tertiary care university hospital between 01/01/2006 and 10/31/2012. Data reported include admission time (day defined from 8am to 4pm based on staffing), first blood gas, use of induced hypothermia (IH) and time from admission to initiation of hypothermia. A good neurologic outcome after 6 months was reported as CPC 1 or 2.
Results:
Of 1172 OHCA patients admitted during the study period, 970 patients (73.8% male, n= 716) with a median age of 60 (IQR 49-70) were included. Times from arrest to ROSC, and ROSC to admission were similar in day- and night-admissions [19 (IQR 10-29) min vs. 18 (IQR 8-29) min; p= 0.69 and 36 (IQR 24-51) vs. 38 (IQR 24-52) min; p=0.58, respectively]. Similarly, there was no difference between day and night in first measured pH (7.17 vs. 7.16; p=0.9) and lactate (7.3 vs. 7.9 mmol/l; p=0.54) after admission. Induced hypothermia was applied to 338 (75.6%) of 447 day-admissions and to 410 (78.4%) of 523 night-admissions (p =0.30). For the patients whose cooling was initiated after admission, time from admission to cooling start did not differ between day and night (mean time 52 ± 5 minutes during day vs. 58 ± 8 minutes at night, p=0.54). At 6 months, a good neurologic outcome was achieved in 202 patients (45.2%) after day admission and 231 patients (44.2%) after night admission (p= 0.75).
Conclusion:
Patients admitted to our facility after OHCA were equally likely to receive timely high-quality post-resuscitation care irrespective of time of day. Similarly, favorable neurologic outcomes did not differ between day and nighttime admissions. Reported circadian differences in OHCA outcomes may be due to differences in the quality of post-resuscitation care provided at non-specialized centers.
Perioperative Cardiac Arrest: A 3-Year Prospective Study from a Tertiary Care University Hospital
