• Steven C Brooks, Damon C Scales, Ruxandra Pinto, Katie N Dainty, Elizabeth M Racz, Michelle Gaudio, Andre C K B Amaral, Sara H Gray, Jan O Friedrich, Martin Chapman, Paul Dorian, Neil Fam, Robert A Fowler, Chris W Hayes, Andrew Baker, Eugene Crystal, Mina Madan, Gordon Rubenfeld, Orla M Smith, and Laurie J Morrison.
• 1Department of Emergency Medicine, Queen's University, Kingston, ON, Canada. 2Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario Canada. 3Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 4Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON. 6Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada. 7Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada. 8Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. 9Heart and Vascular Program, St. Michael's Hospital, Toronto, ON, Canada. 10Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada. 11Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada. 12Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
• Crit. Care Med. 2016 Nov 1; 44 (11): 2037-2044.

ObjectiveTo evaluate whether a Post-Arrest Consult Team improved care and outcomes for patients with out-of-hospital cardiac arrest.DesignProspective cohort study of Post-Arrest Consult Team implementation at two hospitals, with concurrent controls from 27 others.SettingTwenty-nine hospitals within the Strategies for Post-Arrest Care Network of Southern Ontario, Canada.PatientsWe included comatose adult nontraumatic out-of-hospital cardiac arrest patients surviving more than or equal to 6 hours after emergency department arrival who had no contraindications to targeted temperature management.InterventionThe Post-Arrest Consult Team was an advisory consult service to improve 1) targeted temperature management, 2) assessment for percutaneous coronary intervention, 3) electrophysiology assessment, and 4) appropriately delayed neuroprognostication.Measurements And Main ResultsWe used generalized linear mixed models to explore the association between Post-Arrest Consult Team implementation and performance of targeted processes. We included 1,006 patients. The Post-Arrest Consult Team was associated with a significant reduction over time in rates of withdrawal of life-sustaining therapy within 72 hours of emergency department arrival on the basis of predictions of poor neurologic prognosis (ratio of odds ratios, 0.13; 95% CI, 0.02-0.98). Post-Arrest Consult Team was not associated with improved successful targeted temperature management (ratio of odds ratios, 0.91; 95% CI, 0.31-2.65), undergoing angiography (ratio of odds ratios, 1.91; 95% CI, 0.17-21.04), receiving electrophysiology consultation (ratio of odds ratios, 0.93; 95% CI, 0.11-8.16), or functional survival (ratio of odds ratios, 0.75; 95% CI, 0.19-2.94).ConclusionsImplementation of a Post-Arrest Consult Team reduced premature withdrawal of life-sustaining therapy but did not improve rates of successful targeted temperature management, coronary angiography, formal electrophysiology assessments, or functional survival for comatose patients after out-of-hospital cardiac arrest.

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