Helle Søholm1, Jesper Kjaergaard2, John Bro-Jeppesen2, Jakob Hartvig-Thomsen2, Freddy Lippert2, Lars Køber2, Niklas Nielsen2, Magaly Engsig2, Morten Steensen2, Michael Wanscher2, Finn Michael Karlsen2, Christian Hassager2. 1. From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte University Hospital, Hellerup, Denmark (M.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (F.M.K.). helle.soholm@gmail.com. 2. From the Department of Cardiology 2142, The Heart Centre (H.S., J.K., J.B.-J., J.H.-T., L.K., C.H.), Department of Anesthesiology (M.S.), and Department of Thoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Emergency Medical Services, Copenhagen, The Capital Region of Denmark (F.L.); Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden (N.N.); Department of Anesthesiology, Gentofte University Hospital, Hellerup, Denmark (M.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (F.M.K.).
Abstract
BACKGROUND: Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. METHODS AND RESULTS: Consecutive out-of-hospital cardiac arrest patients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). CONCLUSIONS: Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.
BACKGROUND: Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest. METHODS AND RESULTS: Consecutive out-of-hospital cardiac arrestpatients (n=1078) without ST-segment-elevation myocardial infarction admitted to tertiary centers (54%) and nontertiary hospitals (46%) were included (2002-2011). Patient charts were reviewed focusing on level-of-care and comorbidity. Survival to discharge differed significantly with 45% versus 24% of patients discharged alive (P<0.001), and after adjustment for prognostic factors admissions to tertiary centers were still associated with lower 30-day mortality (hazard ratio, 0.78 [0.64-0.96; P=0.02]), independent of comorbidity. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (<24 hours) and late coronary angiography (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had an echocardiography (OR, 2.8 [2.1-3.7]), and survivors more often had implantable cardioverter defibrillator's implanted (OR, 2.1 [1.2-3.6]). CONCLUSIONS: Admissions to tertiary centers were associated with significantly higher survival after out-of-hospital cardiac arrest in patients without ST-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute to the survival difference; however, differences in comorbidity do not seem to matter significantly.
Authors: Weiting Huang; Gary Kuan Wee Teo; Jack Wei-Chieh Tan; Nur Shahidah Ahmad; Hwee Hong Koh; Marcus Eng Hock Ong Journal: Heart Asia Date: 2018-06-15
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440
Authors: Pedro A Villablanca; Mohammed Makkiya; Evann Einsenberg; David F Briceno; Christia Panagiota; Mark Menegus; Mario Garcia; Daniel Sims; Harish Ramakrishna Journal: Ann Card Anaesth Date: 2016 Jan-Mar