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Multicenter Study
. 2016 Jan 7;5(1):e002670.
doi: 10.1161/JAHA.115.002670.

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

Santiago Garcia  1 , Todd Drexel  2 , Wobo Bekwelem  2 , Ganesh Raveendran  2 , Emily Caldwell  2 , Lucinda Hodgson  2 , Qi Wang  3 , Selcuk Adabag  1 , Brian Mahoney  4 , Ralph Frascone  5 , Gregory Helmer  6 , Charles Lick  7 , Marc Conterato  8 , Kenneth Baran  9 , Bradley Bart  10 , Fouad Bachour  10 , Steven Roh  11 , Carmelo Panetta  12 , Randall Stark  13 , Mark Haugland  14 , Michael Mooney  15 , Keith Wesley  16 , Demetris Yannopoulos  2
Affiliations
Multicenter Study

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol

Santiago Garcia et al. J Am Heart Assoc. .

Abstract

Background: In 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis-St. Paul.

Methods and results: Eleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest. Other inclusion criteria were age >18 and <76 and presumed cardiac etiology. Patients with other rhythms, known do not resuscitate/do not intubate, noncardiac etiology, significant bleeding, and terminal disease were excluded. The primary outcome was survival to hospital discharge with favorable neurological outcome. Patients (315 out of 331) who were resuscitated from VT/VF and transferred alive to the Emergency Department had complete medical records. Of those, 231 (73.3%) were taken to the CCL per the Minnesota Resuscitation Consortium protocol while 84 (26.6%) were not taken to the CCL (protocol deviations). Overall, 197 (63%) patients survived to hospital discharge with good neurological outcome (cerebral performance category of 1 or 2). Of the patients who followed the Minnesota Resuscitation Consortium protocol, 121 (52%) underwent percutaneous coronary intervention, and 15 (7%) underwent coronary artery bypass graft. In this group, 151 (65%) survived with good neurological outcome, whereas in the group that did not follow the Minnesota Resuscitation Consortium protocol, 46 (55%) survived with good neurological outcome (adjusted odds ratio: 1.99; [1.07-3.72], P=0.03).

Conclusions: Early access to the CCL after cardiac arrest due to a shockable rhythm in a selected group of patients is feasible in a large metropolitan area in the United States and is associated with a 65% survival rate to hospital discharge with a good neurological outcome.

Keywords: cardiac arrest; cardiac catheterization; prognosis; revascularization.

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Figures

Figure 1
Figure 1
The Minnesota Resuscitation Consortium (MRC) protocol for the treatment of out‐of‐hospital cardiac arrest (OHCA) due to shockable rhythms. CCL indicates cardiac catheterization lab; DNR/DNI, do not resuscitate/do not intubate; ED, emergency department; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation; STEMI, ST‐segment elevation myocardial infarction; VF/VT, ventricular fibrillation/ventricular tachycardia.
Figure 2
Figure 2
Flow diagram of the Minnesota Resuscitation Consortium study cohort 2013–2014. This study comprised 315 patients with shockable rhythms that had complete data. CCL indicates cardiac catheterization lab; ED, emergency department; OHCA, out‐of‐hospital cardiac arrest; VF/VT, ventricular fibrillation/ventricular tachycardia.
Figure 3
Figure 3
Histogram depicting time to access the cardiac catheterization laboratory (CCL) after arrival to the emergency department (ED) (N=231). The majority of patients gained access to the CCL within 2 hours.
See this image and copyright information in PMC

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