Predictors of Survival and Favorable Functional Outcomes After an Out-of-Hospital Cardiac Arrest in Patients Systematically Brought to a Dedicated Heart Attack Center (from the Harefield Cardiac Arrest Study)
Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OO...
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| Veröffentlicht in: | The American journal of cardiology 2015-03, Vol.115 (6), p.730-737 |
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| creator | Iqbal, M. Bilal, MD Al-Hussaini, Abtehale, MD Rosser, Gareth, MD Salehi, Saleem, MD Phylactou, Maria, MD Rajakulasingham, Ramyah, MD Patel, Jayna, MD Elliott, Katharine, MD Mohan, Poornima, MD Green, Rebecca, MD Whitbread, Mark, MSc Smith, Robert, MD Ilsley, Charles, MD |
| description | Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital—a designated HAC in London. We analyzed (1) all-cause mortality and (2) functional status using a modified Rankin scale (mRS 0 to 6, where mRS0-3+ = favorable functional status). The overall survival rates were 66.7% (30 days) and 62.1% (1 year); and 54.5% had mRS0-3+ at discharge. Patients with mRS0-3+ had reduced mortality compared to mRS0-3− : 30 days (1.2% vs 72.2%, p |
| doi_str_mv | 10.1016/j.amjcard.2014.12.033 |
| format | Article |
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Bilal, MD ; Al-Hussaini, Abtehale, MD ; Rosser, Gareth, MD ; Salehi, Saleem, MD ; Phylactou, Maria, MD ; Rajakulasingham, Ramyah, MD ; Patel, Jayna, MD ; Elliott, Katharine, MD ; Mohan, Poornima, MD ; Green, Rebecca, MD ; Whitbread, Mark, MSc ; Smith, Robert, MD ; Ilsley, Charles, MD</creator><creatorcontrib>Iqbal, M. Bilal, MD ; Al-Hussaini, Abtehale, MD ; Rosser, Gareth, MD ; Salehi, Saleem, MD ; Phylactou, Maria, MD ; Rajakulasingham, Ramyah, MD ; Patel, Jayna, MD ; Elliott, Katharine, MD ; Mohan, Poornima, MD ; Green, Rebecca, MD ; Whitbread, Mark, MSc ; Smith, Robert, MD ; Ilsley, Charles, MD</creatorcontrib><description>Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital—a designated HAC in London. We analyzed (1) all-cause mortality and (2) functional status using a modified Rankin scale (mRS 0 to 6, where mRS0-3+ = favorable functional status). The overall survival rates were 66.7% (30 days) and 62.1% (1 year); and 54.5% had mRS0-3+ at discharge. Patients with mRS0-3+ had reduced mortality compared to mRS0-3− : 30 days (1.2% vs 72.2%, p <0.001) and 1 year (5.3% vs 77.2%, p <0.001). Multivariate analyses identified lower patient comorbidity, absence of cardiogenic shock, bystander CPR, ventricular tachycardia/ventricullar fibrillation as initial rhythm, shorter duration of resuscitation, prehospital advanced airway, absence of adrenaline and inotrope use, and intra-aortic balloon pump use as predictors of mRS0-3+ . Consistent predictors of increased mortality were the presence of cardiogenic shock, advanced airway use, increased duration of resuscitation, and absence of therapeutic hypothermia. A streamlined delivery of patients experiencing OOHCA to dedicated facilities is associated with improved functional status and survival. Our study supports the standardization of care for such patients with the widespread adoption of HACs.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2014.12.033</identifier><identifier>PMID: 25644852</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Cardiac arrest ; Cardiopulmonary Resuscitation ; Cardiovascular ; Cardiovascular disease ; Comorbidity ; Confidence intervals ; Coronary vessels ; Electrocardiography ; Emergency Medical Services ; Epinephrine - administration & dosage ; Female ; Heart attacks ; Heart surgery ; Hospitals, University ; Humans ; Intervention ; Intubation ; London - epidemiology ; Male ; Middle Aged ; Mortality ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Older people ; Out-of-Hospital Cardiac Arrest - diagnosis ; Out-of-Hospital Cardiac Arrest - etiology ; Out-of-Hospital Cardiac Arrest - mortality ; Out-of-Hospital Cardiac Arrest - physiopathology ; Out-of-Hospital Cardiac Arrest - therapy ; Patient Discharge ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Severity of Illness Index ; Shock, Cardiogenic - mortality ; Standard of Care ; Studies ; Survival Rate ; Time Factors ; Treatment Outcome ; United Kingdom - epidemiology ; Variables</subject><ispartof>The American journal of cardiology, 2015-03, Vol.115 (6), p.730-737</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 15, 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-1094a82930ed14842c7a78381b554682617c977955747e42b0c8a5a764fd844e3</citedby><cites>FETCH-LOGICAL-c518t-1094a82930ed14842c7a78381b554682617c977955747e42b0c8a5a764fd844e3</cites><orcidid>0000-0002-6304-5455</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914914023157$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25644852$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iqbal, M. Bilal, MD</creatorcontrib><creatorcontrib>Al-Hussaini, Abtehale, MD</creatorcontrib><creatorcontrib>Rosser, Gareth, MD</creatorcontrib><creatorcontrib>Salehi, Saleem, MD</creatorcontrib><creatorcontrib>Phylactou, Maria, MD</creatorcontrib><creatorcontrib>Rajakulasingham, Ramyah, MD</creatorcontrib><creatorcontrib>Patel, Jayna, MD</creatorcontrib><creatorcontrib>Elliott, Katharine, MD</creatorcontrib><creatorcontrib>Mohan, Poornima, MD</creatorcontrib><creatorcontrib>Green, Rebecca, MD</creatorcontrib><creatorcontrib>Whitbread, Mark, MSc</creatorcontrib><creatorcontrib>Smith, Robert, MD</creatorcontrib><creatorcontrib>Ilsley, Charles, MD</creatorcontrib><title>Predictors of Survival and Favorable Functional Outcomes After an Out-of-Hospital Cardiac Arrest in Patients Systematically Brought to a Dedicated Heart Attack Center (from the Harefield Cardiac Arrest Study)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital—a designated HAC in London. We analyzed (1) all-cause mortality and (2) functional status using a modified Rankin scale (mRS 0 to 6, where mRS0-3+ = favorable functional status). The overall survival rates were 66.7% (30 days) and 62.1% (1 year); and 54.5% had mRS0-3+ at discharge. Patients with mRS0-3+ had reduced mortality compared to mRS0-3− : 30 days (1.2% vs 72.2%, p <0.001) and 1 year (5.3% vs 77.2%, p <0.001). Multivariate analyses identified lower patient comorbidity, absence of cardiogenic shock, bystander CPR, ventricular tachycardia/ventricullar fibrillation as initial rhythm, shorter duration of resuscitation, prehospital advanced airway, absence of adrenaline and inotrope use, and intra-aortic balloon pump use as predictors of mRS0-3+ . Consistent predictors of increased mortality were the presence of cardiogenic shock, advanced airway use, increased duration of resuscitation, and absence of therapeutic hypothermia. A streamlined delivery of patients experiencing OOHCA to dedicated facilities is associated with improved functional status and survival. Our study supports the standardization of care for such patients with the widespread adoption of HACs.</description><subject>Aged</subject><subject>Cardiac arrest</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Coronary vessels</subject><subject>Electrocardiography</subject><subject>Emergency Medical Services</subject><subject>Epinephrine - administration & dosage</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart surgery</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Intervention</subject><subject>Intubation</subject><subject>London - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - therapy</subject><subject>Older people</subject><subject>Out-of-Hospital Cardiac Arrest - diagnosis</subject><subject>Out-of-Hospital Cardiac Arrest - etiology</subject><subject>Out-of-Hospital Cardiac Arrest - mortality</subject><subject>Out-of-Hospital Cardiac Arrest - physiopathology</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Patient Discharge</subject><subject>Predictive Value of Tests</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Shock, Cardiogenic - mortality</subject><subject>Standard of Care</subject><subject>Studies</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United Kingdom - epidemiology</subject><subject>Variables</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFksGO0zAQhiMEYpeFRwBZ4rIcUjyOnTgXUCmUIq20KxXOlutMWHeTuNhOpb4lj4RDC0i9cLLG_mb-mfmdZS-BzoBC-XY70_3WaN_MGAU-AzajRfEouwRZ1TnUUDzOLimlLK-B1xfZsxC2KQQQ5dPsgomScynYZfbzzmNjTXQ-ENeS9ej3dq87ooeGLPXeeb3pkCzHwUTrhvRwO0bjegxk3kb0iZtuctfmKxd2NiZikZqy2pC59xgisQO509HiEANZH0LEPkVGd92BfPBu_H4fSXREk49THzpiQ1aofSTzGLV5IIuUmHSuW-96Eu-RrLTH1mLXnAut49gc3jzPnrS6C_jidF5l35afvi5W-c3t5y-L-U1uBMiYA625lqwuKDbAJWem0pUsJGyE4KVkJVSmrqpaiIpXyNmGGqmFrkreNpJzLK6y62PdnXc_xqSvehsMdp0e0I1BQVlSDpILmdDXZ-jWjT4t8zeVjGA1pYkSR8p4F0KaUe287bU_KKBqslxt1clyNVmugKlkecp7dao-bnps_mb98TgB748ApnXsLXoVTLLDpH17NFE1zv5X4t1ZBdPZYTLxAQ8Y_k2jQkpQ6-nfTd8OOGUFiKr4BbeY1P0</recordid><startdate>20150315</startdate><enddate>20150315</enddate><creator>Iqbal, M. 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Bilal, MD ; Al-Hussaini, Abtehale, MD ; Rosser, Gareth, MD ; Salehi, Saleem, MD ; Phylactou, Maria, MD ; Rajakulasingham, Ramyah, MD ; Patel, Jayna, MD ; Elliott, Katharine, MD ; Mohan, Poornima, MD ; Green, Rebecca, MD ; Whitbread, Mark, MSc ; Smith, Robert, MD ; Ilsley, Charles, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-1094a82930ed14842c7a78381b554682617c977955747e42b0c8a5a764fd844e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Cardiac arrest</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Comorbidity</topic><topic>Confidence intervals</topic><topic>Coronary vessels</topic><topic>Electrocardiography</topic><topic>Emergency Medical Services</topic><topic>Epinephrine - administration & dosage</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Heart surgery</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Intervention</topic><topic>Intubation</topic><topic>London - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - therapy</topic><topic>Older people</topic><topic>Out-of-Hospital Cardiac Arrest - diagnosis</topic><topic>Out-of-Hospital Cardiac Arrest - etiology</topic><topic>Out-of-Hospital Cardiac Arrest - mortality</topic><topic>Out-of-Hospital Cardiac Arrest - physiopathology</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Patient Discharge</topic><topic>Predictive Value of Tests</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Shock, Cardiogenic - mortality</topic><topic>Standard of Care</topic><topic>Studies</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United Kingdom - epidemiology</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iqbal, M. 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Bilal, MD</au><au>Al-Hussaini, Abtehale, MD</au><au>Rosser, Gareth, MD</au><au>Salehi, Saleem, MD</au><au>Phylactou, Maria, MD</au><au>Rajakulasingham, Ramyah, MD</au><au>Patel, Jayna, MD</au><au>Elliott, Katharine, MD</au><au>Mohan, Poornima, MD</au><au>Green, Rebecca, MD</au><au>Whitbread, Mark, MSc</au><au>Smith, Robert, MD</au><au>Ilsley, Charles, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of Survival and Favorable Functional Outcomes After an Out-of-Hospital Cardiac Arrest in Patients Systematically Brought to a Dedicated Heart Attack Center (from the Harefield Cardiac Arrest Study)</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2015-03-15</date><risdate>2015</risdate><volume>115</volume><issue>6</issue><spage>730</spage><epage>737</epage><pages>730-737</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital—a designated HAC in London. We analyzed (1) all-cause mortality and (2) functional status using a modified Rankin scale (mRS 0 to 6, where mRS0-3+ = favorable functional status). The overall survival rates were 66.7% (30 days) and 62.1% (1 year); and 54.5% had mRS0-3+ at discharge. Patients with mRS0-3+ had reduced mortality compared to mRS0-3− : 30 days (1.2% vs 72.2%, p <0.001) and 1 year (5.3% vs 77.2%, p <0.001). Multivariate analyses identified lower patient comorbidity, absence of cardiogenic shock, bystander CPR, ventricular tachycardia/ventricullar fibrillation as initial rhythm, shorter duration of resuscitation, prehospital advanced airway, absence of adrenaline and inotrope use, and intra-aortic balloon pump use as predictors of mRS0-3+ . Consistent predictors of increased mortality were the presence of cardiogenic shock, advanced airway use, increased duration of resuscitation, and absence of therapeutic hypothermia. A streamlined delivery of patients experiencing OOHCA to dedicated facilities is associated with improved functional status and survival. Our study supports the standardization of care for such patients with the widespread adoption of HACs.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25644852</pmid><doi>10.1016/j.amjcard.2014.12.033</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6304-5455</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2015-03, Vol.115 (6), p.730-737 |
| issn | 0002-9149 1879-1913 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1660418458 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Aged Cardiac arrest Cardiopulmonary Resuscitation Cardiovascular Cardiovascular disease Comorbidity Confidence intervals Coronary vessels Electrocardiography Emergency Medical Services Epinephrine - administration & dosage Female Heart attacks Heart surgery Hospitals, University Humans Intervention Intubation London - epidemiology Male Middle Aged Mortality Myocardial Infarction - complications Myocardial Infarction - mortality Myocardial Infarction - therapy Older people Out-of-Hospital Cardiac Arrest - diagnosis Out-of-Hospital Cardiac Arrest - etiology Out-of-Hospital Cardiac Arrest - mortality Out-of-Hospital Cardiac Arrest - physiopathology Out-of-Hospital Cardiac Arrest - therapy Patient Discharge Predictive Value of Tests Reproducibility of Results Retrospective Studies Risk Assessment Risk Factors Sensitivity and Specificity Severity of Illness Index Shock, Cardiogenic - mortality Standard of Care Studies Survival Rate Time Factors Treatment Outcome United Kingdom - epidemiology Variables |
| title | Predictors of Survival and Favorable Functional Outcomes After an Out-of-Hospital Cardiac Arrest in Patients Systematically Brought to a Dedicated Heart Attack Center (from the Harefield Cardiac Arrest Study) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T19%3A17%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Predictors%20of%20Survival%20and%20Favorable%20Functional%20Outcomes%20After%20an%20Out-of-Hospital%20Cardiac%20Arrest%20in%20Patients%20Systematically%20Brought%20to%20a%20Dedicated%20Heart%20Attack%20Center%20(from%20the%20Harefield%20Cardiac%20Arrest%20Study)&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=Iqbal,%20M.%20Bilal,%20MD&rft.date=2015-03-15&rft.volume=115&rft.issue=6&rft.spage=730&rft.epage=737&rft.pages=730-737&rft.issn=0002-9149&rft.eissn=1879-1913&rft.coden=AJCDAG&rft_id=info:doi/10.1016/j.amjcard.2014.12.033&rft_dat=%3Cproquest_cross%3E3628953781%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1664482900&rft_id=info:pmid/25644852&rft_els_id=S0002914914023157&rfr_iscdi=true |