Treatment and Outcomes of ST Segment Elevation Myocardial Infarction and Out-of-Hospital Cardiac Arrest in a Regionalized System of Care Based on Presence or Absence of Initial Shockable Cardiac Arrest Rhythm

Jue, Thomas; Bosson, Nichole; Kaji, Amy H.; Ji, Yong; Sung, Gene; Shavelle, David M.; French, William J.; Koenig, William; Niemann, James T.

doi:10.1016/j.amjcard.2014.07.006

Cited by 21 publications

(6 citation statements)

References 17 publications

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“…Guideline recommendations suggest UCA in the setting of STelevation on the post-arrest ECG. Despite these recommendations, only 71% of patients with STEMI in this cohort underwent UCA, similar to an analysis of UCA among cardiac arrest survivors with STEMI [19].…”

Section: Discussionsupporting

confidence: 61%

“…Guideline recommendations suggest UCA in the setting of ST‐elevation on the post‐arrest ECG. Despite these recommendations, only 71% of patients with STEMI in this cohort underwent UCA, similar to an analysis of UCA among cardiac arrest survivors with STEMI . We found numerous conditions suggestive of futility or that a new thrombotic occlusion of a coronary vessel was not the etiology of OHCA among patients with ST‐elevation who did not undergo UCA.…”

Section: Discussionsupporting

confidence: 56%

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Factors associated with performing urgent coronary angiography in out‐of‐hospital cardiac arrest patients

Lam

Glassmoyer

Strom

et al. 2017

Cathet Cardio Intervent

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Section: Discussionsupporting

confidence: 61%

Section: Discussionsupporting

confidence: 56%

Factors associated with performing urgent coronary angiography in out‐of‐hospital cardiac arrest patients

Lam

Glassmoyer

Strom

et al. 2017

Cathet Cardio Intervent

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“…28 In a large metropolitan area in the United Kingdom, patients with STEMI complicated by OHCA who were resuscitated and then transported to a specialist STEMI center for angiography and selective PCI had a high rate of survival (66%). 29 In a secondary analysis of data from a multicenter randomized trial of field interventions in patients with OHCA, 30 use of hospital-based intervention was observed but not mandated or randomly allocated.…”

mentioning

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

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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

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“…The relationship of candidate variables with outcome was initially assessed in a univariate manner using logistic regression; these were retained in the model if the p value was less than 0.20. The decision was made a priori to force three selected variables into the model (time to ROSC, age, initial shockable rhythm), regardless of statistical significance, on the basis of prior evidence suggesting significant prognostic value [25][26][27][28]. A hierarchical logistic regression model for good outcome as a function of patient demographic and clinical variables was created with a random center-specific effect.…”

Section: Discussionmentioning

confidence: 99%

Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry

et al. 2019

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Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient-and arrest-specific characteristics and evaluated how in-hospital management differs between high-and low-performing centers. Methods: Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, preexisting functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. Results: A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. Conclusions: Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.

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Treatment and Outcomes of ST Segment Elevation Myocardial Infarction and Out-of-Hospital Cardiac Arrest in a Regionalized System of Care Based on Presence or Absence of Initial Shockable Cardiac Arrest Rhythm

Cited by 21 publications

References 17 publications

Factors associated with performing urgent coronary angiography in out‐of‐hospital cardiac arrest patients

Factors associated with performing urgent coronary angiography in out‐of‐hospital cardiac arrest patients

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

Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry

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