Abstract 207: Postresuscitation Care and Outcomes of Out-of-Hospital Cardiac Arrest in Korea: A Nationwide Propensity Score Matching Analysis

Abstract

Objective : Active post-resuscitation care (APC) strategy showed improved out-of-hospital cardiac arrest (OHCA) outcomes in well controlled trials. This study aimed to determine whether APC is associated with improved OHCA outcomes in Korea, nationwide level. Methods : We used a national OHCA cohort data composed of hospital and ambulance data, including all EMS-treated OHCA survivors from January 2008 to December 2010. We excluded cases with presumed non-cardiac etiology, those without available hospital outcome data and those with age under 15 years old. The APC group is OHCA patients received coronary reperfusion therapy, therapeutic mild hypothermia, coronary artery bypass surgery (CABG), and pacemaker insertion as well as conservative intensive care (CIC). The primary and secondary outcome was survival to discharge and good neurologic outcome (cerebral performance category (CPC) 1 to 2). We extracted propensity matched sample to contol selection bias. Mutivariable logistic regression analysis was used and we adjusted for potential risk factors to calculate adjusted odds ratios (OR) and 95% confidence intervals (95% CIs). Results : Among 64,155 EMS-assessed OHCA patients with available outcome, 44,794 adults patients with presumed cardiac etiology were collected excluding non-cardiac etiology (n=17,970) and pediatric (n=1,391). Of these, 4,557 patients survived to admission were used for final analysis. 1,599 (35.1%) cases survived to discharge and 499 (11.0%) cases discharged with good neurologic recovery. 695 cases (15.3%) received any APC including mild hypothermia (n=377, 8.3%), reperfusion therapy (n=307, 6.7%), CABG (n=18, 0.4%), and pacemaker insertion (n=61, 1.3%). Survival to discharge rate was higher in APC group than CIC group (58.7% vs. 30.8%, p <0.001). Good neurologic outcome was also higher in APC group than CIC group (27.2% vs. 8.0%, p<0.001). Adjusted ORs of APC versus CIC group was 2.12 (95% CI 1.76-2.55) for survival to discharge and 2.53 (95% CI 1.99-3.21) for good neurologic outcome. For propensity score matched cohort, adjusted ORs for survival to discharge and good neurologic outcome of APC was significantly favor. Conclusions : The APC strategy in Korea increased by year and showed significant improved outcomes.