Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers

Peberdy, Mary Ann; Donnino, Michael W.; Callaway, Clifton W.; DiMaio, J. Michael; Geocadin, Romergryko G.; Ghaemmaghami, Chris A.; Jacobs, Alice K.; Kern, Karl B.; Levy, Jerrold H.; Link, Mark S.; Menon, Venu; Ornato, Joseph P.; Pinto, Duane S.; Sugarman, Jeremy; Yannopoulos, Demetris; Ferguson, T. Bruce

doi:10.1161/cir.0b013e3182a15cd2

Cited by 85 publications

(53 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The American Heart Association has published a scientific statement that describes the obstacles in clinical implementation of early access to the CCL for this patient population 21. Efforts to keep OHCA mortality rates separate from standard PCI procedures are warranted and ongoing 21.…”

Section: Discussionmentioning

confidence: 99%

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

García

Drexel

Bekwelem

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundIn 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis‐St. Paul.Methods and ResultsEleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and <76 and presumed cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07–3.72], P=0.03).ConclusionsEarly access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital discharge with a good neurological outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

García

Drexel

Bekwelem

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Because patients who have OHCA associated with STEMI have a higher mortality than those with STEMI alone, individual providers and hospitals have disincentives to provide potentially efficacious care to the newly resuscitated. 96 Recognizing the absence of accurate symptoms or signs to assess neurological prognosis in the emergency department, 76,97 AHA guidelines have argued that case selection for emergent angiography after resuscitation should be independent of neurological assessment. This conflicts with hospital and physician concerns about reportable outcomes data related to postprocedure, specifically mortality, and the public perception of publicly reported numbers.…”

Section: Referring and Receiving Facilitiesmentioning

confidence: 99%

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

McCarthy¹,

Carr²,

Sasson³

et al. 2018

Circulation

Self Cite

View full text Add to dashboard Cite

ABSTRACT:The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation.1 Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States.2 One third of cases occur without any prior recognized heart disease; half occur without any prodromal symptoms.3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care.4-6 As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care. The American Heart Association (AHA) previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, EMS, and hospital efforts to measure and improve the process and outcome of care for patients with cardiac arrest.10 Simultaneously, the AHA proposed a national process to develop and implement evidence-based guidelines for the implementation and measurement of such systems. The 2015 AHA guidelines for CPR and emergency cardiovascular care delved deeper into the elements of an effective system of care for both OHCA and in-hospital cardiac arrest.11 This update on OHCA resuscitation systems of care describes recent advances, evidence

show abstract

“…Nevertheless, many of those variables that influence clinician's perception such as frailty 48 are not well captured in electronic health records or structured data and therefore are challenging to add to risk models. 49 This theoretical concern about unmeasured difference in hospital case mix may in fact have confounded reporting of outlier hospitals. In Massachusetts, all 4 hospitals marked as negative outliers were tertiary referral centers, which often accept complex transfers from other facilities.…”

Section: Concerns About the Validity Of Publicly Reported Datamentioning

confidence: 99%

“…16 Although the topic remains controversial, the American Heart Association has recently released a scientific statement suggesting that excluding certain critically ill populations from publicly reported risk-adjusted mortality after PCI is necessary to preserve access to care. 49 More broadly, the inclusion of only selected patients in all qualityreporting processes is founded on the notion that hospitals may serve fundamentally different populations from one another and that certain processes are driven by patient choice or other unavoidable factors for which individual hospitals should not be held responsible. Nevertheless, this selection process creates opportunities for "gaming the system" and has the potential to erode the face validity of the reported data.…”

Section: Exclusion Of Groups Of Patients From Public Reportingmentioning

confidence: 99%

“…We support the exclusion of extremely high-risk patients from public reporting, consistent with the American Heart Association's recommendation to exclude patients with out-of-hospital cardiac arrest in PCI mortality reporting. 49 Even despite these types of exclusions, because mortality public reporting may shift procedures from high-risk patients to low-risk patients who may be less likely to benefit from procedures, procedural public reporting should include measures of appropriateness. Including appropriateness in public reporting for procedures not only safeguards against overuse in low-risk patients but also provides the public information about providers' focus on value for patients.…”

Section: Identify Better Outcome Measures To Assess Qualitymentioning

confidence: 99%

See 1 more Smart Citation

Public Reporting in Cardiovascular Medicine

et al. 2015

View full text Add to dashboard Cite

Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers

Cited by 85 publications

References 44 publications

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

Public Reporting in Cardiovascular Medicine

Contact Info

Product

Resources

About