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Observational Study
. 2018 Nov 19;26(1):98.
doi: 10.1186/s13049-018-0568-0.

Factors determining level of hospital care and its association with outcome after resuscitation from pre-hospital pulseless electrical activity

Sini Saarinen  1 , Ari Salo  2 , James Boyd  2 , Päivi Laukkanen-Nevala  3 , Catharina Silfvast  4 , Ilkka Virkkunen  3 , Tom Silfvast  5
Affiliations
Observational Study

Factors determining level of hospital care and its association with outcome after resuscitation from pre-hospital pulseless electrical activity

Sini Saarinen et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Patients resuscitated from out-of-hospital cardiac arrest (OHCA) with pulseless electrical activity (PEA) as initial cardiac rhythm are not always treated in intensive care units (ICUs): some are admitted to high dependency units with various level of care, others to ordinary wards. Aim of this study was to describe the factors determining level of hospital care after OHCA with PEA, post-resuscitation care and survival.

Methods: Adult OHCA patients with PEA (n = 221), who were resuscitated in southern Finland between 2010 and 2013 were included, provided patient survived to hospital admission. The patients were divided into four groups according to the level of hospital care provided: ordinary ward and Level 1-3 ICUs. Differences in patient characteristics, post-resuscitation care and survival were compared between the groups.

Results: Most patients (62.4%) were treated at Level 2 ICUs. Longer time to ROSC and advanced age decreased admission rate to Level 2 or 3 post-resuscitation care, whereas good pre-arrest CPC (1-2) increased the admission rate to Level 2/3 ICUs independently. Treatment with targeted temperature management (TTM) (4.1%) or early coronary angiography (3.2%) were very rare. Prognostic decisions were made earlier in the lower treatment intensity groups (p < 0.01). One-year survival rate was 24.0, 17.1% survived with good neurological outcome. Neurological outcome was better with more intensive care. After adjustment, level of care was not independent predictor for outcome: only return of spontaneous circulation (ROSC) time, cardiac arrest cause and pre-arrest performance affected independently to 1-year survival, age and ROSC for neurologic outcome.

Conclusions: PEA are usually admitted to Level 2 ICUs for post-resuscitation care in the capital area of Finland. Age, ROSC and pre-arrest CPC were independent predictors for level of post-resuscitation care. TTM and early CAG were rare and provided only for Level 3 ICU patients. Prognostication was earlier in lower level of care units. Good neurologic survival was more common with more intensive level of post-resuscitation care. After adjustment, level of care was not independent predictor for survival or neurologic outcome: only ROSC, cardiac arrest cause and pre-arrest performance predicted 1-year survival; age and ROSC neurologic outcome.

Keywords: Cardiopulmonary resuscitation; Heart arrest; Post-resuscitation care; Pulseless electrical activity.

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Conflict of interest statement

Ethics approval and consent to participate

Permission to conduct the study was granted by the Helsinki University Hospital Research and Development Division. Because this study used retrospectively collected data, the researchers were not required to submit the study protocol for ethical board review.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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