Introduction Out of hospital cardiac arrest (OHCA) represents a common presentation to both the emergency department and the catheter lab. Understanding of the factors associated with poor outcome in this patient group is limited; thus management decisions are challenging. The aim of this analysis was to retrospectively review clinical records for OHCA patients undergoing catheter lab procedures to determine factors associated with poor outcome.
Methods Data on patients undergoing coronary angiography and percutaneous coronary intervention (PCI) between January 2009 and May 2015 at a tertiary cardiac centre were retrospectively reviewed. A keyword search was performed on all records to identify relevant procedures and these results were manually reviewed by two authors to confirm they were OHCA cases. Cases were excluded if they initially presented to a different hospital and were later transferred for investigation. Procedure details, discharge summaries, blood results and mortality data were reviewed.
Results 27 578 angiogram or PCI procedures were carried out between January 2009 and May 2015; 242 (0.9%) of these were patients presenting with OHCA. Forty-two patients (17.3%) died within 30 days of presentation. Demographic details of this population are shown in Table 1. Univariate analysis revealed that blood gas pH and lactate were strongly correlated with 30 day mortality (p<0.001 and p=0.002 respectively). Other factors associated with 30 day mortality included presentation with cardiogenic shock, intubation pre-hospital or in the emergency department (but not in the ?catheter lab) and the development of pulseless electrical activity (PEA) at any time (table 2). Culprit vessel (p=0.810), ST-elevation at presentation, and age were not significantly associated with 30 day mortality (p=0.426 and p=0.085 respectively). Furthermore, there was no difference in mortality between those who underwent PCI and those who received angiography alone.
Conclusion OHCA constituted 0.9% of activity during the period of review. There were significant correlations between 30 day mortality and several biochemical and clinical markers available at presentation. The use of these markers may be of use in triaging patients who are likely to benefit from interventional procedures.
- Out of Hospital Cardiac Arrest
- Percutaneous Coronary Intervention
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