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Abstract
Introduction William Harvey Hospital (WHH) is a busy DGH in Kent and a Regional PPCI centre covering a population of 1.4 million with approximately 650 PPCI per year. This is a Consultant led service with no Junior on call. It has by default become a regional centre for OOHCA regardless of STEMI. This has serious implications on a rather modest ITU resource with 11 beds (9 ventilated, 2 HDU) and admission is often prolonged.
The management of OOHCA patients has been topical, with the necessity and timing of invasive angiography at the forefront. This retrospective study aimed to audit the outcomes of OOHCA patients admitted to WHH with an emphasis on culprit lesions and timing of angiography.
Methods This was a retrospective audit, of 101 patients admitted January 2016 – May 2017 to WHH ITU post OOHCA. All patients were intubated and ventilated. The ITU electronic database, cardiac catheter Cardio Flow resource provided cardiac catheterisation reports. The electronic source Patient Centre provided discharge diagnosis and survival information; including overall mortality and neurological outcomes. ECG’s were reviewed electronically via the life-net system for presenting rhythm.
Results 101 consecutive OOHCA patients who were intubated and ventilated, were included. 84 patients (83%) presented with VF arrest and 17 (17%) presented with PEA/Asystole.
67 patients (66%) underwent early invasive angiography. 45 patients who underwent angiography (67%) had an identifiable culprit lesion. Of 67 patients undergoing angiography, 41 (61%) underwent immediate PCI. 2 (3%) patients were transferred for CABG and 2 patients (3%) had failed PCI. 6% of patients with culprit lesion had bystander disease.
22 patients (33% of all undergoing angiography and 22% of the overall cohort) had a Primary Arrhythmogenic Arrest (PAA). Within the PAA group, 11 (50%) did not survive. 45% survived to ICD insertion. 5% were transferred to a tertiary centre.
Overall, 9 patients (9%) had a final non-cardiological diagnosis, (community acquired pneumonia, intra-cranial event and hypokalaemia). Overall inpatient mortality was 51%. Of 50 survivors (50%) 41 patients were discharged home. Of these patients, 38% had cognitive impairment.
Conclusions
9 patients (9%) were clearly medical & immediate angiography could have been potentially harmful
Of those who underwent early angiography, 33% had a Primary arrhythmia & did not require immediate revascularisation. Out of this group 45% survived & 50% died following angiography in hospital.
29% of patients undergoing emergency PCI did not have ST elevation post ROSC on admission ECG
The results of ongoing work such as the ARREST TRIAL are awaited for further guidance on the management of these difficult patients.
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