Prognosis Following Out of Hospital Cardiac Arrest
Objectives The aim of the study was to assess the influence of percutaneous coronary intervention (PCI) and therapeutic hypothermia (TH) on long-term prognosis.
Background Although hospital care consisting of TH and/or PCI in particular patients resuscitated following out-of-hospital cardiac arrest (OHCA) can improve survival to hospital discharge, there is little evidence regarding how these therapies may impact long-term prognosis.
Methods We performed a cohort investigation of all persons >18 years of age who suffered nontraumatic OHCA and were resuscitated and discharged alive from the hospital between January 1, 2001, and December 31, 2009, in a metropolitan emergency medical service (EMS) system. We reviewed EMS and hospital records, state death certificates, and the national death index to determine clinical characteristics and vital status. Survival analyses were conducted using Kaplan-Meier estimates and multivariable Cox regression. Analyses of TH were restricted to those patients who were comatose at hospital admission.
Results Of the 5,958 persons who received EMS-attempted resuscitation, 1,001 (16.8%) were discharged alive from the hospital. PCI was performed in 384 of 1,001 (38.4%), whereas TH was performed in 241 of 941 (25.6%) persons comatose at hospital admission. Five-year survival was 78.7% among those treated with PCI compared with 54.4% among those not receiving PCI and 77.5% among those treated with TH compared with 60.4% among those not receiving TH (both p < 0.001). After adjustment for confounders, PCI was associated with a lower risk of death (hazard ratio [HR]: 0.46 [95% confidence interval [CI]: 0.34 to 0.61]; p < 0.001). Likewise, TH was associated with a lower risk of death (HR: 0.70 [95% CI: 0.50 to 0.97]; p = 0.04).
Conclusions The findings suggested that effects of acute hospital interventions for post-resuscitation treatment extend beyond hospital survival and can positively influence prognosis following the arrest hospitalization.
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Opportunities to improve OHCA survival, and in turn, public health depend in part on the chain of survival. The links in the chain include early activation of emergency response, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced therapies, and integrated post-resuscitation care. Increasing evidence supports a role for hospital-based interventions that can reverse the underlying cause of arrest and limit ischemia-reperfusion injury that often occurs in OHCA. Evidence-based guidelines indicate that hospital care consisting of therapeutic hypothermia (TH) () and/or percutaneous coronary intervention (PCI) in particular patients can improve functional hospital survival.
However, there is little evidence regarding how these therapies may impact long-term prognosis. Ultimately, an optimal public health assessment of therapy reflects both short- and long-term treatment effects. We hypothesized that the potential short-term survival benefit of hospital-based interventions of TH and PCI following OHCA would be amplified following hospital discharge and so would be associated with a reduction in mortality following hospital discharge.
Abstract and Introduction
Abstract
Objectives The aim of the study was to assess the influence of percutaneous coronary intervention (PCI) and therapeutic hypothermia (TH) on long-term prognosis.
Background Although hospital care consisting of TH and/or PCI in particular patients resuscitated following out-of-hospital cardiac arrest (OHCA) can improve survival to hospital discharge, there is little evidence regarding how these therapies may impact long-term prognosis.
Methods We performed a cohort investigation of all persons >18 years of age who suffered nontraumatic OHCA and were resuscitated and discharged alive from the hospital between January 1, 2001, and December 31, 2009, in a metropolitan emergency medical service (EMS) system. We reviewed EMS and hospital records, state death certificates, and the national death index to determine clinical characteristics and vital status. Survival analyses were conducted using Kaplan-Meier estimates and multivariable Cox regression. Analyses of TH were restricted to those patients who were comatose at hospital admission.
Results Of the 5,958 persons who received EMS-attempted resuscitation, 1,001 (16.8%) were discharged alive from the hospital. PCI was performed in 384 of 1,001 (38.4%), whereas TH was performed in 241 of 941 (25.6%) persons comatose at hospital admission. Five-year survival was 78.7% among those treated with PCI compared with 54.4% among those not receiving PCI and 77.5% among those treated with TH compared with 60.4% among those not receiving TH (both p < 0.001). After adjustment for confounders, PCI was associated with a lower risk of death (hazard ratio [HR]: 0.46 [95% confidence interval [CI]: 0.34 to 0.61]; p < 0.001). Likewise, TH was associated with a lower risk of death (HR: 0.70 [95% CI: 0.50 to 0.97]; p = 0.04).
Conclusions The findings suggested that effects of acute hospital interventions for post-resuscitation treatment extend beyond hospital survival and can positively influence prognosis following the arrest hospitalization.
Introduction
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Opportunities to improve OHCA survival, and in turn, public health depend in part on the chain of survival. The links in the chain include early activation of emergency response, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced therapies, and integrated post-resuscitation care. Increasing evidence supports a role for hospital-based interventions that can reverse the underlying cause of arrest and limit ischemia-reperfusion injury that often occurs in OHCA. Evidence-based guidelines indicate that hospital care consisting of therapeutic hypothermia (TH) () and/or percutaneous coronary intervention (PCI) in particular patients can improve functional hospital survival.
However, there is little evidence regarding how these therapies may impact long-term prognosis. Ultimately, an optimal public health assessment of therapy reflects both short- and long-term treatment effects. We hypothesized that the potential short-term survival benefit of hospital-based interventions of TH and PCI following OHCA would be amplified following hospital discharge and so would be associated with a reduction in mortality following hospital discharge.
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