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. 2020 Jun 1;5(1):32-36.
doi: 10.29045/14784726.2020.06.5.1.32.

A service evaluation of transport destination and outcome of patients with post-ROSC STEMI in an English ambulance service

Anthony Platt  1
Affiliations

A service evaluation of transport destination and outcome of patients with post-ROSC STEMI in an English ambulance service

Anthony Platt. Br Paramed J. .

Abstract

Background: In the UK, there are approximately 60,000 cases of out-of-hospital cardiac arrest (OHCA) each year. There is mounting evidence that post-resuscitation care should include early angiography and primary percutaneous coronary intervention (pPCI) in cases of OHCA where a cardiac cause is suspected. Yorkshire Ambulance Service (YAS) staff can transport patients with a return of spontaneous circulation (ROSC) directly to a pPCI unit if their post-ROSC ECG shows evidence of ST elevation myocardial infarction (STEMI). This service evaluation aimed to determine the factors that affect the transport destination, hospital characteristics and 30-day survival rates of post-ROSC patients with presumed cardiac aetiology.

Methods: All patient care records (PCRs) previously identified for the AIRWAYS-2 trial between January and July 2017 were reviewed. Patients were eligible for inclusion if they were an adult non-traumatic OHCA, achieved ROSC on scene and were treated and transported by (YAS). Descriptive statistics were used to analyse the data.

Results: 478 patients met the inclusion criteria. 361/478 (75.6%) patients had a post-ROSC ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a pPCI unit by the attending clinicians. 40/88 (45.5%) of referrals made were accepted by the pPCI units. Patients taken directly to pPCI were most likely to survive to 30 days (25/39, 53.8%), compared to patients taken to an emergency department (ED) at a pPCI-capable hospital (34/126, 27.0%), or an ED at a non-pPCI-capable hospital (50/310, 16.1%).

Conclusion: Staff should be encouraged to record a 12-lead ECG on all post-ROSC patients, and make a referral to the regional pPCI-capable centre if there is evidence of a STEMI, or a cardiac cause is likely, since 30-day survival is highest for patients who are taken directly for pPCI. Ambulance services should continue to work with regional pPCI-capable centres to ensure that suitable patients are accepted to maximise potential for survival.

Keywords: out-of-hospital cardiac arrest; pPCI; post-ROSC care.

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Conflict of interest statement

None declared.

Figures

None
Figure 1. Sankey diagram showing patient journey and survival outcome.
See this image and copyright information in PMC

References

    1. Arabi A., Patel A., Al Suwaldi J., Gehani A., Singh R. & Albinali H. (2018). Clinical profile, management, and outcome in patients with out of hospital cardiac arrest (OHCA) and ST segment elevation myocardial infarction: Insights from a 20-year registry. Angiology, 69(3): 249–255. https://doi.org/10.1177/0003319717699500. - PubMed
    1. Choudry F. A., Weerackody R. P., Timmins A. D., Wragg A., Mathur A., Sporton S. & Jain A. K. (2015). Importance of primary percutaneous intervention for reducing mortality in ST-elevation myocardial infarction complicated by out of hospital cardiac arrest. European Heart Journal: Acute Cardiovascular Care, 4(4), 378–385. https://doi.org/10.1177/2048872614555990. - PubMed
    1. Deakin C. D., Fothergill R., Moore F., Watson L. & Whitbread M. (2014). Level of consciousness on admission to a heart attack centre is a predictor of survival from out-of-hospital cardiac arrest. Resuscitation, 85(7), 905–909. https://doi.org/10.1016/j.resuscitation.2014.02.020. - PubMed
    1. Dicker B., Todd V. F., Tunnage B., Swain A., Smith T. & Howie G. (2019). Direct transport to PCI-capable hospitals after out-of-hospital cardiac arrest in New Zealand: Inequities and outcomes. Resuscitation, 142, 111–116. https://doi.org/10.1016/j-resuscitation.2019.06.283. - PubMed
    1. Fisher M. B., Messerli A. & Whayne T. (2018). Characteristics, management, and results of Out-of-Hospital Cardiac Arrest (OHCA) with or without ST-Segment Elevation Myocardial Infarction (STEMI). Angiology, 69(3), 189–191. https://doi-org.libaccess.hud.ac.uk/10.1177/0003319717709686. - PubMed

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