Primary percutaneous coronary angioplasty and therapeutic hypothermia in out-of-hospital cardiac arrest
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KeywordsCardiac Arrest Coronary Angioplasty Therapeutic Hypothermia Coronary Occlusion Percutaneous Intervention
The benefit of primary percutaneous intervention (PCI) in the management of out-of-hospital cardiac arrest (OHCA) is not clear cut . It has historically been used in patients with ST elevation on post-resuscitation electrocardiogram (ECG) although this is a poor predictor of acute coronary occlusion after cardiac arrest . This study investigates the benefit of PCI regardless of post-resuscitation ECG. Benefit is widely claimed for therapeutic hypothermia, so cooling parameters were included.
We analysed all 41 consecutive adults admitted post OHCA to a university hospital ICU between January 2010 and December 2011. Patients received PCI regardless of ECG changes. A Cox proportional hazards model was used to determine the relationship between PCI, cooling and survival to discharge. Routinely collected data such as demographics and details of resuscitation (OHCA Utstein data) were also included.
Survival to hospital discharge was 41% with 29% of survivors discharged to a neurological rehabilitation centre. Multivariate analysis using a Cox proportional hazards model showed PCI to be an independent predictive factor of survival, unrelated to ECG (hazards ratio, 0.0583; 95% CI, 0.0076 to 0.4485). Cooling had no significant impact on patient survival. See Figure 1.
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