Out-of-Hospital Cardiac Arrest: Evaluation of Patient Outcomes and Impact on ICU Resources
Background - Recent guidelines recommend that patients resuscitated from out-of-hospital cardiac arrest (OHCA) and whose ECGs show ST-segment elevation (STE) receive immediate angiography with a view to primary percutaneous coronary intervention (PPCI), while those without STE should also be considered for angiography and PPCI1. We set out to evaluate the impact of expanding PPCI provision on patient outcomes and ICU resource use.
Methods - Data on all patients admitted to a tertiary hospital via the PPCI pathway between January 2010 and December 2015 were analysed. Additional data from patients who sustained OHCA were analysed with respect to ICU admission and outcomes.
Results - 301 patients resuscitated from OHCA were admitted via the PPCI pathway during the study period. The number and proportion of OHCA cases increased from 5.5% (n=38) of total admissions in 2010 to 8.4% (n=67) in 2015. Mean number of co-morbidities per patient increased from 0.97 to 1.63 from 2010 to 2015. The proportion of OHCA patients diagnosed with definite myocardial infarction (MI) decreased from 92% (2010) to 60% (2015), while the proportion diagnosed with acute coronary syndrome (ACS) increased from 0% to 31%. More required ICU admission (13% in 2010 to 58% in 2015) and support for two or more organ systems (11% in 2010 to 48% in 2015). Rate of survival to hospital discharge decreased from 100% in 2010 to 81% in 2015, and the proportions who were discharged without neurological deficit (92% in 2010 to 63% in 2015) and discharged home (95% in 2010 to 58% in 2015) both decreased. Declines in rate of survival to hospital discharge and proportion discharged to home were more pronounced among those admitted to ICU as compared to those not admitted to ICU.
Conclusion - Our findings suggest that more patients resuscitated from OHCA are being admitted via the PPCI pathway, with an increasing trend in patients with multiple existing co-morbidities. Despite higher rates of ICU admission and higher levels of organ support, smaller proportions achieve favourable outcomes. Our data suggest that expanding PPCI provision to more patients resuscitated from OHCA places increasing demands on limited ICU resources.