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Critical Care
Published in: Critical Care 1/2011

Open Access 01-02-2011 | Research

Postresuscitation care with mild therapeutic hypothermia and coronary intervention after out-of-hospital cardiopulmonary resuscitation: a prospective registry analysis

Authors: Jan Thorsten Gräsner, Patrick Meybohm, Amke Caliebe, Bernd W Böttiger, Jan Wnent, Martin Messelken, Tanja Jantzen, Thorsten Zeng, Bernd Strickmann, Andreas Bohn, Hans Fischer, Jens Scholz, Matthias Fischer, the German Resuscitation Registry Study Group

Published in: Critical Care | Issue 1/2011

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Abstract

Introduction

Mild therapeutic hypothermia (MTH) has been shown to result in better neurological outcome after cardiopulmonary resuscitation. Percutaneous coronary intervention (PCI) may also be beneficial in patients after out-of-hospital cardiac arrest (OHCA).

Methods

A selected cohort study of 2,973 prospectively documented adult OHCA patients within the German Resuscitation Registry between 2004 and 2010. Data were analyzed by backwards stepwise binary logistic regression to identify the impact of MTH and PCI on both 24-hour survival and neurological outcome that was based on cerebral performance category (CPC) at hospital discharge. Odds ratios (95% confidence intervals) were calculated adjusted for the following confounding factors: age, location of cardiac arrest, presumed etiology, bystander cardiopulmonary resuscitation, witnessing, first electrocardiogram rhythm, and thrombolysis.

Results

The Preclinical care dataset included 2,973 OHCA patients with 44% initial return of spontaneous circulation (n = 1,302) and 35% hospital admissions (n = 1,040). Seven hundred and eleven out of these 1,040 OHCA patients (68%) were also registered within the Postresuscitation care dataset. Checking for completeness of datasets required the exclusion of 127 Postresuscitation care cases, leaving 584 patients with complete data for final analysis. In patients without PCI (n = 430), MTH was associated with increased 24-hour survival (8.24 (4.24 to 16.0), P < 0.001) and the proportion of patients with CPC 1 or CPC 2 at hospital discharge (2.13 (1.17 to 3.90), P < 0.05) as an independent factor. In normothermic patients (n = 405), PCI was independently associated with increased 24-hour survival (4.46 (2.26 to 8.81), P < 0.001) and CPC 1 or CPC 2 (10.81 (5.86 to 19.93), P < 0.001). Additional analysis of all patients (n = 584) revealed that 24-hour survival was increased by MTH (7.50 (4.12 to 13.65), P < 0.001) and PCI (3.88 (2.11 to 7.13), P < 0.001), while the proportion of patients with CPC 1 or CPC 2 was significantly increased by PCI (5.66 (3.54 to 9.03), P < 0.001) but not by MTH (1.27 (0.79 to 2.03), P = 0.33), although an unadjusted Fisher exact test suggested a significant effect of MTH (unadjusted odds ratio 1.83 (1.23 to 2.74), P < 0.05).

Conclusions

PCI may be an independent predictor for good neurological outcome (CPC 1 or CPC 2) at hospital discharge. MTH was associated with better neurological outcome, although subsequent logistic regression analysis did not show statistical significance for MTH as an independent predictor for good neurological outcome. Thus, postresuscitation care on the basis of standardized protocols including coronary intervention and hypothermia may be beneficial after successful resuscitation. One of the main limitations may be a selection bias for patients subjected to PCI and MTH.
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Literature
1.
Lund-Kordahl I, Olasveengen TM, Lorem T, Samdal M, Wik L, Sunde K: Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local Chain of Survival; quality of advanced life support and post-resuscitation care. Resuscitation 2010, 81: 422-426. 10.1016/j.resuscitation.2009.12.020PubMedCrossRef
2.
Hayashi H, Ujike Y: Out-of hospital cardiac arrest in Okayama city (Japan): outcome report according to the 'Utstein Style'. Acta Med Okayama 2005, 59: 49-54.PubMed
3.
Herlitz J, Bang A, Gunnarsson J, Engdahl J, Karlson BW, Lindqvist J, Waagstein L: Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg, Sweden. Heart 2003, 89: 25-30. 10.1136/heart.89.1.25PubMedPubMedCentralCrossRef
4.
Herlitz J, Svensson L, Holmberg S, Angquist KA, Young M: Efficacy of bystander CPR: intervention by lay people and by health care professionals. Resuscitation 2005, 66: 291-295. 10.1016/j.resuscitation.2005.04.003PubMedCrossRef
5.
Iwami T, Kawamura T, Hiraide A, Berg RA, Hayashi Y, Nishiuchi T, Kajino K, Yonemoto N, Yukioka H, Sugimoto H, Kakuchi H, Sase K, Yokoyama H, Nonogi H: Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation 2007, 116: 2900-2907. 10.1161/CIRCULATIONAHA.107.723411PubMedCrossRef
6.
Nolan JP, Morley PT, Hoek TL, Hickey RW: Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation 2003, 57: 231-235. 10.1016/S0300-9572(03)00184-9PubMedCrossRef
7.
Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW, Kloeck WG, Billi J, Bottiger BW, Morley PT, Nolan JP, Okada K, Reyes C, Shuster M, Steen PA, Weil MH, Wenzel V, Hickey RW, Carli P, Vanden Hoek TL, Atkins D: Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation 2003, 108: 118-121. 10.1161/01.CIR.0000079019.02601.90PubMedCrossRef
8.
HACA: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002, 346: 549-556. 10.1056/NEJMoa012689CrossRef
9.
Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K: Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002, 346: 557-563. 10.1056/NEJMoa003289PubMedCrossRef
10.
Boden WE, Gupta V: Reperfusion strategies in acute ST-segment elevation myocardial infarction. Curr Opin Cardiol 2008, 23: 613-619. 10.1097/HCO.0b013e3283131357PubMedCrossRef
11.
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction - executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004, 110: 588-636. 10.1161/01.CIR.0000134791.68010.FAPubMedCrossRef
12.
Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM: Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology. Heart 2003, 89: 839-842. 10.1136/heart.89.8.839PubMedPubMedCentralCrossRef
13.
Böttiger BW, Grabner C, Bauer H, Bode C, Weber T, Motsch J, Martin E: Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area. Heart 1999, 82: 674-679.PubMedPubMedCentralCrossRef
14.
Wolfrum S, Pierau C, Radke PW, Schunkert H, Kurowski V: Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention. Crit Care Med 2008, 36: 1780-1786. 10.1097/CCM.0b013e31817437caPubMedCrossRef
15.
Böttiger BW, Arntz HR, Chamberlain DA, Bluhmki E, Belmans A, Danays T, Carli PA, Adgey JA, Bode C, Wenzel V: Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 2008, 359: 2651-2662.PubMedCrossRef
16.
Marcusohn E, Roguin A, Sebbag A, Aronson D, Dragu R, Amikam S, Boulus M, Grenadier E, Kerner A, Nikolsky E, Markiewicz W, Hammerman H, Kapeliovich M: Primary percutaneous coronary intervention after out-of-hospital cardiac arrest: patients and outcomes. Isr Med Assoc J 2007, 9: 257-259.PubMed
17.
Sunde K, Pytte M, Jacobsen D, Mangschau A, Jensen LP, Smedsrud C, Draegni T, Steen PA: Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007, 73: 29-39. 10.1016/j.resuscitation.2006.08.016PubMedCrossRef
18.
Dumas F, Cariou A, Manzo-Silberman S, Grimaldi D, Vivien B, Rosencher J, Empana JP, Carli P, Mira JP, Jouven X, Spaulding C: Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry. Circ Cardiovasc Interv 2010, 3: 200-207. 10.1161/CIRCINTERVENTIONS.109.913665PubMedCrossRef
19.
Grasner JT, Meybohm P, Fischer M, Bein B, Wnent J, Franz R, Zander J, Lemke H, Bahr J, Jantzen T, Messelken M, Dorges V, Bottiger BW, Scholz J: A national resuscitation registry of out-of-hospital cardiac arrest in Germany - a pilot study. Resuscitation 2009, 80: 199-203. 10.1016/j.resuscitation.2008.10.008PubMedCrossRef
20.
Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D'Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, et al.: Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 2004, 110: 3385-3397. 10.1161/01.CIR.0000147236.85306.15PubMedCrossRef
21.
Grasner JT, Messelken M, Fischer M, Jantzen T, Bahr J, Bottiger BW, Dorges V, Franz R, Gries A, Krieter H, Schuttler J, Wnent J, Zander JF, Scholz J: The DGAI CPR registry - the datasets 'hospital care' and 'long-term process'. Anasthesiol Intensivmed Notfallmed Schmerzther 2008, 43: 706-709. 10.1055/s-0028-1102989PubMedCrossRef
22.
Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, Bossaert L, Delooz HH, Dick WF, Eisenberg MS, Evans TR, Holmberg S, Kerber R, Mullie A, Ornato JP, Sandoe E, Skulberg A, Tunstall-Pedoe H, Swanson R, Thies WH: Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991, 84: 960-975.PubMedCrossRef
23.
Safar P: Cerebral resuscitation after cardiac arrest: research initiatives and future directions. Ann Emerg Med 1993, 22: 324-349. 10.1016/S0196-0644(05)80463-9PubMedCrossRef
24.
Nolan J, Laver S: Outcome of out-of-hospital cardiac arrest. Anaesthesia 2007, 62: 1082-1083. 10.1111/j.1365-2044.2007.05279_1.xPubMedCrossRef
25.
Fridman M, Barnes V, Whyman A, Currell A, Bernard S, Walker T, Smith KL: A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register. Resuscitation 2007, 75: 311-322. 10.1016/j.resuscitation.2007.05.005PubMedCrossRef
26.
Fredriksson M, Herlitz J, Engdahl J: Nineteen years' experience of out-of-hospital cardiac arrest in Gothenburg - reported in Utstein style. Resuscitation 2003, 58: 37-47. 10.1016/S0300-9572(03)00115-1PubMedCrossRef
27.
Rudner R, Jalowiecki P, Karpel E, Dziurdzik P, Alberski B, Kawecki P: Survival after out-of-hospital cardiac arrests in Katowice (Poland): outcome report according to the 'Utstein style'. Resuscitation 2004, 61: 315-325. 10.1016/j.resuscitation.2004.01.020PubMedCrossRef
28.
Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I: Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008, 300: 1423-1431. 10.1001/jama.300.12.1423PubMedPubMedCentralCrossRef
29.
Beiser DG, Carr GE, Edelson DP, Peberdy MA, Hoek TL: Derangements in blood glucose following initial resuscitation from in-hospital cardiac arrest: a report from the national registry of cardiopulmonary resuscitation. Resuscitation 2009, 80: 624-630. 10.1016/j.resuscitation.2009.02.011PubMedPubMedCentralCrossRef
30.
Olasveengen TM, Eftestol T, Gundersen K, Wik L, Sunde K: Acute ischemic heart disease alters ventricular fibrillation waveform characteristics in out-of hospital cardiac arrest. Resuscitation 2009, 80: 412-417. 10.1016/j.resuscitation.2009.01.012PubMedCrossRef
31.
Herlitz J, Engdahl J, Svensson L, Young M, Angquist KA, Holmberg S: Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden. Resuscitation 2004, 60: 283-290. 10.1016/j.resuscitation.2003.11.003PubMedCrossRef
32.
Hollenberg J, Herlitz J, Lindqvist J, Riva G, Bohm K, Rosenqvist M, Svensson L: Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew - witnessed cases and bystander cardiopulmonary resuscitation. Circulation 2008, 118: 389-396. 10.1161/CIRCULATIONAHA.107.734137PubMedCrossRef
33.
Herlitz J, Svensson L, Silfverstolpe J, Angquist KA, Wisten A, Engdahl J, Holmberg S: Characteristics and outcome amongst young adults suffering from out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation is attempted. J Intern Med 2006, 260: 435-441. 10.1111/j.1365-2796.2006.01705.xPubMedCrossRef
34.
Bernard SA: Hypothermia improves outcome from cardiac arrest. Crit Care Resusc 2005, 7: 325-327.PubMed
35.
Spaulding CM, Joly LM, Rosenberg A, Monchi M, Weber SN, Dhainaut JF, Carli P: Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 1997, 336: 1629-1633. 10.1056/NEJM199706053362302PubMedCrossRef
36.
Gorjup V, Radsel P, Kocjancic ST, Erzen D, Noc M: Acute ST-elevation myocardial infarction after successful cardiopulmonary resuscitation. Resuscitation 2007, 72: 379-385. 10.1016/j.resuscitation.2006.07.013PubMedCrossRef
37.
Keeley EC, Cigarroa JE: Facilitated primary percutaneous transluminal coronary angioplasty for acute ST segment elevation myocardial infarction: rationale for reuniting pharmacologic and mechanical revascularization strategies. Cardiol Rev 2003, 11: 13-20. 10.1097/00045415-200301000-00004PubMedCrossRef
38.
Reynolds JC, Callaway CW, El Khoudary SR, Moore CG, Alvarez RJ, Rittenberger JC: Coronary angiography predicts improved outcome following cardiac arrest: propensity-adjusted analysis. J Intensive Care Med 2009, 24: 179-186. 10.1177/0885066609332725PubMedPubMedCentralCrossRef
39.
Kajino K, Iwami T, Daya M, Nishiuchi T, Hayashi Y, Kitamura T, Irisawa T, Sakai T, Kuwagata Y, Hiraide A, Kishi M, Yamayoshi S: Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest. Resuscitation 2010, 81: 549-554. 10.1016/j.resuscitation.2010.02.008PubMedCrossRef
40.
Davies MJ: Anatomic features in victims of sudden coronary death. Coronary artery pathology. Circulation 1992, 85: I19-I24.PubMed
41.
Eisenberg MS, Mengert TJ: Cardiac resuscitation. N Engl J Med 2001, 344: 1304-1313. 10.1056/NEJM200104263441707PubMedCrossRef
42.
Hovdenes J, Laake JH, Aaberge L, Haugaa H, Bugge JF: Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock. Acta Anaesthesiol Scand 2007, 51: 137-142. 10.1111/j.1399-6576.2006.01209.xPubMedCrossRef
43.
Nielsen N, Hovdenes J, Nilsson F, Rubertsson S, Stammet P, Sunde K, Valsson F, Wanscher M, Friberg H: Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2009, 53: 926-934. 10.1111/j.1399-6576.2009.02021.xPubMedCrossRef
Metadata
Title
Postresuscitation care with mild therapeutic hypothermia and coronary intervention after out-of-hospital cardiopulmonary resuscitation: a prospective registry analysis
Authors
Jan Thorsten Gräsner
Patrick Meybohm
Amke Caliebe
Bernd W Böttiger
Jan Wnent
Martin Messelken
Tanja Jantzen
Thorsten Zeng
Bernd Strickmann
Andreas Bohn
Hans Fischer
Jens Scholz
Matthias Fischer
the German Resuscitation Registry Study Group
Publication date
01-02-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10035

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