☆ 4.4 Article

Comparison of Role of Early (Less Than Six Hours) to Later (More Than Six Hours) or No Cardiac Catheterization After Resuscitation From Out-of-Hospital Cardiac Arrest

AMERICAN JOURNAL OF CARDIOLOGY (2012)

Journal

AMERICAN JOURNAL OF CARDIOLOGY

Volume 109, Issue 4, Pages 451-454

Publisher

EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC

DOI: 10.1016/j.amjcard.2011.09.036

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Funding

Medic One Foundation, Seattle, Washington
National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland [RO1 HL089554]

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Abstract

Despite reports of patients with resuscitated sudden cardiac arrest (rSCA) receiving acute cardiac catheterization, the efficacy of this strategy is largely unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge. A retrospective cohort of 240 patients with out-of-hospital rSCA caused by ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington from 1999 through 2002. Patients were grouped into those receiving acute catheterization within 6 hours (<= 6-hour group, n = 61) and those with deferred catheterization at > 6 hours or no catheterization during the index hospitalization (> 6-hour group, n = 179). Attention was directed to survival to hospital discharge, neurologic status, extent of coronary artery disease, presenting electrocardiographic findings, and symptoms before arrest. Propensity-score methods were used to adjust for the likelihood of receiving acute catheterization. Survival was greater in patients who underwent acute catheterization (72% in the <= 6-hour group vs 49% in the > 6-hour group, p = 0.001). Percutaneous coronary intervention was performed in 38 of 61 patients (62%) in the. <= 6-hour group and 13 of 170 patients (7%) in the > 6-hour group (p < 0.0001). Neurologic status was similar in the 2 groups. A significantly larger percentage of patients in the acute catheterization group had symptoms before cardiac arrest and had ST-segment elevation on electrocardiogram after resuscitation. Age, bystander cardiopulmonary resuscitation, daytime presentation, history of percutaneous coronary intervention or stroke, and acute ST-segment elevation were positively associated with receiving cardiac catheterization. In conclusion, in this series of patients who sustained out-of-hospital cardiac arrest, acute catheterization (< 6 hours of presentation) was associated with improved survival. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:451-454)

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Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Jun Wei Yeo, Zi Hui Celeste Ng, Amelia Xin Chun Goh, Jocelyn Fangjiao Gao, Nan Liu, Shao Wei Sean Lam, Yew Woon Chia, Gavin D. Perkins, Marcus Eng Hock Ong, Andrew Fu Wah Ho

Summary: This study found that care at cardiac arrest centers (CACs) was associated with improved survival and neurological outcomes for patients with nontraumatic out-of-hospital cardiac arrest. The benefits were consistent regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. The evidence for bypassing hospitals or interhospital transfer remains inconclusive.

JOURNAL OF THE AMERICAN HEART ASSOCIATION (2022)