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. 2008 Dec;79(3):398-403.
doi: 10.1016/j.resuscitation.2008.07.015. Epub 2008 Oct 31.

Cardiac catheterization is underutilized after in-hospital cardiac arrest

Raina M Merchant  1 , Benjamin S Abella, Monica Khan, Kuang-Ning Huang, David G Beiser, Robert W Neumar, Brendan G Carr, Lance B Becker, Terry L Vanden Hoek
Affiliations

Cardiac catheterization is underutilized after in-hospital cardiac arrest

Raina M Merchant et al. Resuscitation. 2008 Dec.

Abstract

Background: Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival.

Methods: Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using Chi-square, and adjusted analyses were performed using logistic regression.

Results: One hundred and ten in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within 1 day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, p<.05).

Conclusion: In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.

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Conflict of interest statement

Conflicts of interest:

Raina M. Merchant, MD: no conflict of interest

Benjamin S. Abella, MD, MPhil: Grants (Philips Medical Systems, Cardiac Science Corp), Honoraria/Speaking Fees (Medic First Aid, Alsius Corp, Laerdal)

Monica Khan: no conflict of interest

Kuang-Ning Huang, BA: no conflict of interest

David B. Beiser, MD: no conflict of interest

Robert W. Neumar, MD PhD: no conflict of interest

Brendan G. Carr, MD MA: no conflict of interest

Lance B. Becker, MD: Grants (Phillips Medical Systems, Laerdal Medical, Alsius Corporation, NIH, Cardiac Science), Scientific consultant (honoraria/speaking fees): (Abbott Labs, Philips Medical Systems), Patents (Hypothermia Induction Patents), Ownership, equity, royalties in privately held companies (Inventor’s equity and royalties from Cold Core Therapeutics’, INC, a company developing cooling technologies for medical cooling using “slurry” technology)

Terry L. Vanden Hoek, MD: Grants (Department of Defense, Office of Naval Research, Philips Medical Systems), Research Support (Medivance), Patents (Hypothermia Induction Devices and Methods)

Figures

Figure 1
Figure 1
Flow diagram of study population This figure illustrates how exclusion criteria were applied to determine the final study population: in-hospital cardiac arrest patients with return of spontaneous circulation and an initial rhythm of ventricular fibrillation ICD: International Classification of Diseases; VF: ventricular fibrillation; LOS: length of stay; IHCA: in-hospital cardiac arrest; OHCA: out-of hospital cardiac arrest; ROSC: return of spontaneous circulation
See this image and copyright information in PMC

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