Re-examining outcomes after unsuccessful out-of-hospital resuscitation in the era of field termination of resuscitation guidelines and regionalized post-resuscitation care |
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| Affiliation: | 1. Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Boulevard, Santa Fe Springs, CA, United States;2. Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute at Harbor-UCLA, 1000 West Carson Street, Torrance, CA, United States;3. David Geffen School of Medicine at UCLA, 405 Hilgard Avenue, Los Angeles, CA, United States;1. Paediatric Intensive Care, Birmingham Children''s Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom;2. Paediatrics, Royal Belfast Hospital for Sick Children, 180–184 Falls Rd, Belfast BT12 6BE, United Kingdom;3. Department of Epidemiology and Public Health, Queen''s University, Belfast BT9 5EE, United Kingdom;4. Paediatric Intensive Care, Royal Belfast Hospital for Sick Children, 180–184 Falls Rd, Belfast BT12 6BE, United Kingdom;1. Clinical Skills Center, Medical University of Graz, Austria;2. Division of Neonatology, Department of Paediatrics and Adolescence Medicine, Medical University of Graz, Austria;1. Division of Neonatology, Department of Paediatrics and Adolescence Medicine, Medical University of Graz, Austria;2. Department of Pediatrics, University of Alberta, Edmonton, Canada;3. Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Canada;1. Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States;2. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, United States;3. Pittsburgh NMR Center for Biomedical Research, Carnegie Mellon University, Pittsburgh, PA, United States;4. Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States;5. Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States |
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| Abstract: | BackgroundDismal prognosis after failed out-of-hospital resuscitation has previously been demonstrated. Changes in resuscitation and post-resuscitation care may affect patient outcomes. We describe characteristics and outcomes of patients with out-of-hospital cardiac arrest (OOHCA) transported to specialty cardiac centers after failure of out-of-hospital interventions.MethodsIn Los Angeles (LA) County, patients with non-traumatic OOHCA with return of spontaneous circulation (ROSC) are transported to specialized cardiac care centers. Outcomes are reported to a registry maintained by the LA County Emergency Medical Services (EMS) Agency. We report patient characteristics and outcomes for the subset of patients treated at these specialty centers in whom initial ROSC was achieved in the ED. The primary outcome was neurologically intact survival, defined by a cerebral performance category (CPC) score of 1 or 2.Results105 patients transported to the SRC after failure to achieve ROSC with out-of-hospital resuscitation were successfully resuscitated in the ED. The median age was 68 years (IQR 57–78); 74 (70%) were male. The presenting rhythm was ventricular fibrillation or ventricular tachycardia in 40 patients (38%) and 86 (82%) were witnessed. Twenty-two patients (21%) survived to hospital discharge. Of the 103 patients with known CPC scores, 13 (13% [95% CI 7–21%]) survived to hospital discharge with a CPC score of 1 or 2. No patient who survived with good neurologic outcome met criteria for termination of resuscitation in the field.ConclusionFailure of out-of-hospital resuscitation is not universally predictive of poor neurologic outcome. |
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| Keywords: | Heart arrest Cardiopulmonary resuscitation Mortality Survival |
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