Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest

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

doi:10.1016/j.resuscitation.2013.12.028

Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest

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

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

142 Scopus citations

Abstract

Background: The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (≤24. h after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA. Methods: We 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 ≥60. min. 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). Results: From 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). Interpretation: : Early 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.

Original language	English (US)
Pages (from-to)	657-663
Number of pages	7
Journal	Resuscitation
Volume	85
Issue number	5
DOIs	https://doi.org/10.1016/j.resuscitation.2013.12.028
State	Published - May 2014

Keywords

Coronary angiography
Fibrinolysis
Heart arrest
Hypothermia
Percutaneous coronary intervention

ASJC Scopus subject areas

Emergency Medicine
Emergency
Cardiology and Cardiovascular Medicine

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10.1016/j.resuscitation.2013.12.028

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Callaway, C. W., Schmicker, R. H., Brown, S. P., Albrich, J. M., Andrusiek, D. L., Aufderheide, T. P., Christenson, J., Daya, M. R., Falconer, D., Husa, R. D., Idris, A. H., Ornato, J. P., Rac, V. E., Rea, T. D., Rittenberger, J. C., Sears, G., & Stiell, I. G. (2014). Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest. Resuscitation, 85(5), 657-663. https://doi.org/10.1016/j.resuscitation.2013.12.028

Callaway, CW, Schmicker, RH, Brown, SP, Albrich, JM, Andrusiek, DL, Aufderheide, TP, Christenson, J, Daya, MR, Falconer, D, Husa, RD, Idris, AH, Ornato, JP, Rac, VE, Rea, TD, Rittenberger, JC, Sears, G & Stiell, IG 2014, 'Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest', Resuscitation, vol. 85, no. 5, pp. 657-663. https://doi.org/10.1016/j.resuscitation.2013.12.028

@article{55119e6538b7476491c8cbf6a878f7e2,

title = "Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest",

abstract = "Background: The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (≤24. h after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA. Methods: We 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 ≥60. min. 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). Results: From 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). Interpretation: : Early 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.",

keywords = "Coronary angiography, Fibrinolysis, Heart arrest, Hypothermia, Percutaneous coronary intervention",

author = "Callaway, {Clifton W.} and Schmicker, {Robert H.} and Brown, {Siobhan P.} and Albrich, {J. Michael} and Andrusiek, {Douglas L.} and Aufderheide, {Tom P.} and James Christenson and Daya, {Mohamud R.} and David Falconer and Husa, {Ruchika D.} and Idris, {Ahamed H.} and Ornato, {Joseph P.} and Rac, {Valeria E.} and Rea, {Thomas D.} and Rittenberger, {Jon C.} and Gena Sears and Stiell, {Ian G.}",

note = "Funding Information: There are no reported conflicts of interest directly related to this work. The ROC is supported by a series of cooperative agreements to nine regional clinical centers and one Data Coordinating Center (5U01 HL077863 – University of Washington Data Coordinating Center, HL077866 – Medical College of Wisconsin, HL077867 – University of Washington, HL077871 – University of Pittsburgh, HL077872 – St. Michael's Hospital, HL077873 – Oregon Health and Science University, HL077881 – University of Alabama at Birmingham, HL077885 – Ottawa Hospital Research Institute, HL077887 – University of Texas SW Medical Ctr/Dallas, HL077908 – University of California San Diego) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, US Army Medical Research and Material Command, The Canadian Institutes of Health Research (CIHR) – Institute of Circulatory and Respiratory Health, Defence Research and Development Canada and the Heart, Stroke Foundation of Canada and the American Heart Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute or the National Institutes of Health. ",

year = "2014",

month = may,

doi = "10.1016/j.resuscitation.2013.12.028",

language = "English (US)",

volume = "85",

pages = "657--663",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

number = "5",

}

TY - JOUR

T1 - Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest

AU - Callaway, Clifton W.

AU - Schmicker, Robert H.

AU - Brown, Siobhan P.

AU - Albrich, J. Michael

AU - Andrusiek, Douglas L.

AU - Aufderheide, Tom P.

AU - Christenson, James

AU - Daya, Mohamud R.

AU - Falconer, David

AU - Husa, Ruchika D.

AU - Idris, Ahamed H.

AU - Ornato, Joseph P.

AU - Rac, Valeria E.

AU - Rea, Thomas D.

AU - Rittenberger, Jon C.

AU - Sears, Gena

AU - Stiell, Ian G.

N1 - Funding Information: There are no reported conflicts of interest directly related to this work. The ROC is supported by a series of cooperative agreements to nine regional clinical centers and one Data Coordinating Center (5U01 HL077863 – University of Washington Data Coordinating Center, HL077866 – Medical College of Wisconsin, HL077867 – University of Washington, HL077871 – University of Pittsburgh, HL077872 – St. Michael's Hospital, HL077873 – Oregon Health and Science University, HL077881 – University of Alabama at Birmingham, HL077885 – Ottawa Hospital Research Institute, HL077887 – University of Texas SW Medical Ctr/Dallas, HL077908 – University of California San Diego) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, US Army Medical Research and Material Command, The Canadian Institutes of Health Research (CIHR) – Institute of Circulatory and Respiratory Health, Defence Research and Development Canada and the Heart, Stroke Foundation of Canada and the American Heart Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute or the National Institutes of Health.

PY - 2014/5

Y1 - 2014/5

N2 - Background: The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (≤24. h after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA. Methods: We 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 ≥60. min. 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). Results: From 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). Interpretation: : Early 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.

AB - Background: The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (≤24. h after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA. Methods: We 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 ≥60. min. 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). Results: From 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). Interpretation: : Early 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.

KW - Coronary angiography

KW - Fibrinolysis

KW - Heart arrest

KW - Hypothermia

KW - Percutaneous coronary intervention

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JO - Resuscitation

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ER -

Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest

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Keywords

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