Abstract 229: Differences in Utilization of Postarrest Care Based on Initial Rhythm

Abstract

Background: Care of successfully resuscitated patients is highly variable. Whether initial rhythm is associated with receiving specific post-arrest interventions has not been explored. Objectives: Determine which specific post-arrest interventions are used in patients who remain comatose after resuscitation and whether use is associated with initial arrest rhythm. Methods: We included comatose post-arrest patients at 27 hospitals between 2000-2014. We examined patient and arrest characteristics and the use of specialist consultations, cardiac catheterization (cath) and electrophysiology (EP) assessments and interventions, targeted temperature management (TTM), EEG monitoring, head CT and MRI scans, echocardiography, withdrawal of life sustaining therapy (WLST) and length of stay, stratified on initial rhythm. Results: A retrospective cohort of 1923 patients was 57% male with a mean age of 62±16 yrs. Of 645 (34%) pts with a shockable initial rhythm, 51% survived to hospital discharge, 89% discharged with CPC 1-2. Of 1278 (66%) pts with a non-shockable initial rhythm, 26% survived to hospital discharge, 73% discharged with CPC 1-2. Patients with initial shockable rhythms were significantly (p<0.05) more likely to have cardiology consults, EEGs, brain MRI scans, echocardiography, TTM, ICDs placed, cath and EP lab visits, longer hospital stays, and not to have WLST than patients with initial non-shockable rhythms. Controlling for cardiac etiology and TTM in logistic regression, cardiology consults, cath and EP lab visits, ICD placement, brain MRIs, echocardiography, and WLST remained significantly different between patients based on initial rhythm (Table 1). Conclusions: Post-arrest care varies between patients and can be influenced by arrest characteristics, such as initial pulseless rhythm. Patients with shockable rhythms are more likely to receive certain post-arrest interventions and testing than patients with non-shockable rhythms.