Coronary Artery Disease
Predictors of Survival and Favorable Functional Outcomes After an Out-of-Hospital Cardiac Arrest in Patients Systematically Brought to a Dedicated Heart Attack Center (from the Harefield Cardiac Arrest Study)

https://doi.org/10.1016/j.amjcard.2014.12.033Get rights and content

Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital—a designated HAC in London. We analyzed (1) all-cause mortality and (2) functional status using a modified Rankin scale (mRS 0 to 6, where mRS0-3+ = favorable functional status). The overall survival rates were 66.7% (30 days) and 62.1% (1 year); and 54.5% had mRS0-3+ at discharge. Patients with mRS0-3+ had reduced mortality compared to mRS0-3: 30 days (1.2% vs 72.2%, p <0.001) and 1 year (5.3% vs 77.2%, p <0.001). Multivariate analyses identified lower patient comorbidity, absence of cardiogenic shock, bystander CPR, ventricular tachycardia/ventricullar fibrillation as initial rhythm, shorter duration of resuscitation, prehospital advanced airway, absence of adrenaline and inotrope use, and intra-aortic balloon pump use as predictors of mRS0-3+. Consistent predictors of increased mortality were the presence of cardiogenic shock, advanced airway use, increased duration of resuscitation, and absence of therapeutic hypothermia. A streamlined delivery of patients experiencing OOHCA to dedicated facilities is associated with improved functional status and survival. Our study supports the standardization of care for such patients with the widespread adoption of HACs.

Section snippets

Methods

This was an observational analysis to determine the predictors of favorable functional status at discharge and long-term survival in 182 consecutive patients experiencing an OOHCA from 2011 to 2013 who were brought directly by the emergency medical services (EMS) to Harefield Hospital, Middlesex—1 of 8 designated heart attack centers in London. Of these, return of spontaneous circulation was achieved in 174 patients (96%) and included in the final analysis. The LAS is the largest free emergency

Results

The patient characteristics are summarized in Table 1. For the 174 patients who were successfully resuscitated, (1) the mortality rate was 33.3% at 30 days and 37.9% at 1 year and (2) 63.5% survived to hospital discharge with 54.6% having a favorable functional status (mRS0-3+).

Multivariate logistic regression analyses were used to identify independent predictors of mRS0-3+ (Figure 1). Consistent predictors of mRS0-3+ in both models included a lower CMI, absence of cardiogenic shock, bystander

Discussion

Despite advances in CPR, functional survival rate remains low after OOHCA.1, 12 Survival is a net result of different factors ranging from application of medical science; public awareness and education; availability of resources and personnel; and local implement of infrastructure. The concept of HACs provides a system of strategically utilizing available resources required to meet the acute and complex need of these patients.12, 13 Studies have shown that 80% of OOHCAs have a cardiac cause,3, 8

Disclosures

The authors have no conflicts of interest to disclose.

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