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J Am Heart Assoc. 2016 Jan 7;5(1). pii: e002670. doi: 10.1161/JAHA.115.002670.

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol.

Author information

1
Division of Cardiology, Department of Medicine, Minneapolis VA Healthcare System and University of Minnesota School of Medicine, Minneapolis, MN (S.G., S.A.).
2
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN (T.D., W.B., G.R., E.C., L.H., D.Y.).
3
Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN (Q.W.).
4
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN (B.M.).
5
Department of Emergency Medicine, Regions Hospital, St. Paul, MN (R.F.).
6
Department of Cardiology, Fairview Southdale Medical Center, Minneapolis, MN (G.H.).
7
Department of Emergency Medicine, Allina Medical Transportation, St. Paul, MN (C.L.).
8
Department of Emergency Medicine, North Memorial Medical Center, Robbinsdale, MN (M.C.).
9
Department of Cardiology, United Hospital, St. Paul, MN (K.B.).
10
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN (B.B., F.B.).
11
Department of Cardiology, North Memorial Medical Center, Robbinsdale, MN (S.R.).
12
Division of Cardiology, Health East Hospital, St. Paul, MN (C.P.).
13
Division of Cardiology, Metropolitan Heart and Vascular Institute, Coon Rapids, MN (R.S.).
14
Division of Cardiology, Park Nicollet Heart and Vascular Center, St. Louis Park, MN (M.H.).
15
Division of Cardiology, Abbott Northwestern Hospital, Minneapolis, MN (M.M.).
16
Health East Emergency Medical Services, St. Paul, MN (K.W.).

Abstract

BACKGROUND:

In 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis-St. Paul.

METHODS AND RESULTS:

Eleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and <76 and presumed cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07-3.72], P=0.03).

CONCLUSIONS:

Early access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital discharge with a good neurological outcome.

KEYWORDS:

cardiac arrest; cardiac catheterization; prognosis; revascularization

PMID:
26744380
PMCID:
PMC4859384
DOI:
10.1161/JAHA.115.002670
[Indexed for MEDLINE]
Free PMC Article

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