Critical-care centers show better cardiac arrest survival rates

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NEW ORLEANS—Survival from out-of-hospital cardiac arrest may improve when initial resuscitation and post-arrest care is provided at a hospital designated as a critical-care center, according to research presented Saturday at the American Heart Association (AHA) Scientific Sessions.

Kenaro Kajino, MD, PhD, an emergency medicine and critical-care investigator from Osaka University Graduate School of Medicine in Osaka, Japan, examined whether treatment in a specialized critical-care hospital results in better outcomes for patients who have had cardiac arrest out of hospital.

“It has been reported that in-hospital post-resuscitation care, including the use of hypothermia and early PCI, improves out-of-hospital cardiac arrest survival,” Kajino said. “Others have reported that hospital differences in survival from all out-of-hospital cardiac arrests are primarily related to pre-hospital factors rather than in-hospital factors or patient characteristics.”

Kajino and his colleagues compared survival outcomes among cardiac arrest patients transported to critical-care centers and non-critical-care hospitals in Osaka. The primary outcome of the study was one-month neurologically favorable survival.

Over the three years of the study, emergency medical technicians (EMT) transported more than 2,800 cardiac arrest patients to hospitals designated as critical-care centers and more than 7,500 cardiac arrest patients to non-critical-care centers.

Kajino noted that in some cases, cardiac arrest patients had a return of spontaneous circulation (ROSC) prior to transport to either type of facility. Other patients were transported without ROSC.

The researchers found that neurologically favorable survival at one month was greater among the patients transported to a critical-care center and resuscitated in hospital than among those taken to a non-critical-care center, after adjusting for confounding variables, such as the patient’s age, gender, transport time and initial rhythm.

“For patients without field ROSC, in-hospital resuscitation and post-resuscitation care in a critical-care center was an independent predictor of outcome,” Kajino said.

However, he noted that among patients who had ROSC in the field, there was no significant difference in neurologically favorable one-month survival outcomes regardless of transport destination.