Background The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (≤24 hours after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA. Methods We performed a secondary analysis of a multicenter clinical trial (NCT00394706) conducted between 2007 and 2009 in 10 North American regions. Subjects were adults (≥ 18 years) hospitalized after OHCA with pulses sustained ≥ 60 minutes. We measured the association of early coronary catheterization, percutaneous coronary intervention, fibrinolysis, and induced hypothermia with survival to hospital discharge with favorable functional status (modified Rankin Score ≤3). Results From 16,875 OHCA subjects, 3,981 (23.6%) arrived at 151 hospitals with sustained pulses. 1,317 (33.1%) survived to hospital discharge, with 1,006 (25.3%) favorable outcomes. Rates of early coronary catheterization (19.2%), coronary reperfusion (17.7%) or induced hypothermia (39.3%) varied between hospitals, and were higher in hospitals treating more subjects per year. Odds of survival and favorable outcome increased with hospital volume (per 5 subjects/year OR 1.06; 95%CI: 1.04–1.08 and OR 1.06; 95%CI: 1.04, 1.08, respectively). Survival and favorable outcome were independently associated with early coronary angiography (OR 1.69; 95%CI 1.06–2.70 and OR 1.87; 95%CI 1.15–3.04), coronary reperfusion (OR 1.94; 95%CI 1.34–2.82 and OR 2.14; 95%CI 1.46–3.14), and induced hypothermia (OR 1.36; 95%CI 1.01–1.83 and OR 1.42; 95%CI 1.04–1.94). Interpretation Early coronary intervention and induced hypothermia are associated with favorable outcome and are more frequent in hospitals that treat higher numbers of OHCA subjects per year.

No abstract

BACKGROUND In‐hospital cardiopulmonary arrest (CPA) accounts for substantial morbidity and mortality. Rapid response teams (RRTs) are designed to prevent non–intensive care unit (ICU) CPA through early detection and intervention. However, existing evidence has not consistently demonstrated a clear benefit. OBJECTIVE To explore the effectiveness of a novel RRT program design to decrease non‐ICU CPA and overall hospital mortality. METHODS This study was conducted from the start of fiscal year 2005 to 2011. In November 2007, our hospitals implemented RRTs as part of a novel resuscitation program. Charge nurses from each inpatient unit underwent training as unit‐specific RRT members. Additionally, all inpatient staff received annual training in RRT concepts including surveillance and recognition of deterioration. We compared the incidence of ICU and non‐ICU CPA from first complete preimplementation year 2006 to postimplementation years 2007 to 2011. Overall hospital mortality was also reported. RESULTS The incidence of non‐ICU CPA decreased, whereas the incidence of ICU CPA remained unchanged. Overall hospital mortality also decreased (2.12% to 1.74%, P < 0.001). The year‐over‐year change in RRT activations was inversely related to the change in Code Blue activations for each inpatient unit (r = −0.68, P < 0.001). CONCLUSION Our novel RRT program was associated with a decreased incidence of non‐ICU CPA and improved hospital mortality. Journal of Hospital Medicine 2015;10:352–357. © 2015 Society of Hospital Medicine