• Clifton W Callaway, Robert H Schmicker, Siobhan P Brown, J Michael Albrich, Douglas L Andrusiek, Tom P Aufderheide, James Christenson, Mohamud R Daya, David Falconer, Ruchika D Husa, Ahamed H Idris, Joseph P Ornato, Valeria E Rac, Thomas D Rea, Jon C Rittenberger, Gena Sears, Ian G Stiell, and ROC Investigators.
• University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: callawaycw@upmc.edu.
• Resuscitation. 2014 May 1; 85 (5): 657663657-63.

BackgroundThe rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (≤24h after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA.MethodsWe performed a secondary analysis of a multicenter clinical trial (NCT00394706) conducted between 2007 and 2009 in 10 North American regions. Subjects were adults (≥18 years) hospitalized after OHCA with pulses sustained ≥60min. We measured the association of early coronary catheterization, percutaneous coronary intervention, fibrinolysis, and induced hypothermia with survival to hospital discharge with favorable functional status (modified Rankin Score≤3).ResultsFrom 16,875 OHCA subjects, 3981 (23.6%) arrived at 151 hospitals with sustained pulses. 1317 (33.1%) survived to hospital discharge, with 1006 (25.3%) favorable outcomes. Rates of early coronary catheterization (19.2%), coronary reperfusion (17.7%) or induced hypothermia (39.3%) varied among hospitals, and were higher in hospitals treating more subjects per year. Odds of survival and favorable outcome increased with hospital volume (per 5 subjects/year OR 1.06; 95%CI: 1.04-1.08 and OR 1.06; 95%CI: 1.04, 1.08, respectively). Survival and favorable outcome were independently associated with early coronary angiography (OR 1.69; 95%CI 1.06-2.70 and OR 1.87; 95%CI 1.15-3.04), coronary reperfusion (OR 1.94; 95%CI 1.34-2.82 and OR 2.14; 95%CI 1.46-3.14), and induced hypothermia (OR 1.36; 95%CI 1.01-1.83 and OR 1.42; 95%CI 1.04-1.94).InterpretationEarly coronary intervention and induced hypothermia are associated with favorable outcome and are more frequent in hospitals that treat higher numbers of OHCA subjects per year.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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