12 Out-of-hospital cardiac arrest: evaluation of patient outcomes and impact on icu resources

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Abstract

Background

Recent European Society of Cardiology guidelines recommend that Primary Percutaneous Coronary Intervention (PPCI) be considered in all patients resuscitated from out-of-hospital cardiac arrest (OHCA).

Methods

We evaluated the impact of expanding PPCI provision on patient outcomes and ICU resources. Data on all patients admitted to a tertiary PPCI centre from 2010 to 2015 were analysed.

Results

301 patients were admitted via the PPCI pathway following OHCA. The number of OHCA patients increased from 5.5% (n=38) of total admissions in 2010 to 8.4% (n=67) in 2015 (p=0.03). Mean number of comorbidities increased from 0.97 to 1.63 (p=0.03). 92% were diagnosed with myocardial infarction in 2010, compared to 60% in 2015 (p<0.001). More patients required ICU admission (13% in 2010 to 58% in 2015, p<0.001) and support for at least two organ systems (11% in 2010 to 48% in 2015, p<0.001). Rate of survival to discharge decreased from 100% to 81% (p=0.004) and proportion discharged home also decreased from 95% to 58% (p<0.001).

Conclusions

Over the study period, the number of OHCA patients admitted to our PPCI centre climbed yearly. They were increasingly likely to have more comorbidity and require more intense organ support. Despite this, outcomes were less favourable. Our findings highlight the need for careful expansion of indications for PPCI admission following OHCA to avoid unsuccessful demand on ICU resources.

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