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Abstract

Introduction: Regionalization of care for high-acuity critical illness is an emerging paradigm that is now advocated for post-cardiac arrest care. Hypothesis: To establish feasability and outcomes of a regional approach to post-cardiac arrest care based at a referral cardiac resuscitation center. Methods: We implemented processes to facilitate early care and transfer of comatose cardiac arrest victims from regional hospitals to a referral cardiac resuscitation center. This is a prospective observational study of all local and referred patients treated in a post-cardiac arrest clinical pathway that included therapeutic hypothermia from November 2007 through June 2011. Clinical data including arrest factors, treatment variables and outcome were collected on consecutive patients with the use of a preformatted standard data collection tool utilizing Utstein criteria. Pittsburgh cerebral performance category (CPC) 1-2 was considered a good neurologic outcome. Results: A total of 220 patients were enrolled; 127 (58%) patients were local direct admissions from our community and 93 (42%) were transferred from one of 24 outlying hospitals. Median age was 57 ± 15 years, median time of arrest to ROSC was 19 minutes (IQR 10-29 minutes), median GCS at enrollment was 3 (IQR 3-3) and 62% of patients presented with a shockable initial cardiac arrest rhythm. STEMI at presentation was the only statistically significant difference in demographic or arrest factors between local and referred patients (8% vs 19%; p=0.01). The primary outcome of good neurologic function was observed in 43% (95% CI: 32% to 48%) of the entire study group and 86% (95% CI: 81% to 94%) of survivors. There was no difference in survival with good neurologic outcome among local and referred patients (46% vs 39%, P=0.3). Conclusions: A regionalized approach to post-cardiac arrest care centering on a referral cardiac resuscitation center is feasible and effective. Medical centers providing state-of-the-art post-cardiac arrest care may impact a greater patient population by working toward local regionalization using previously established referral relationships for other high acuity diseases such STEMI, trauma and acute stroke.