Abstract 34: Survival and Neurological Outcome of Out-of-Hospital Cardiac Arrest in Los Angeles County: Preliminary Results After Regionalization of Care

Abstract

Objective: Post-resuscitation care of cardiac arrest patients at specialized centers may improve outcome after out-of-hospital cardiac arrest (OOHCA). The purpose of this study was to describe recent experience with regionalized care of resuscitated patients in a large metropolitan area and compare it to earlier reported outcomes. Methods: Los Angeles County established regionalized cardiac care in 2006 with a total of 33 designated STEMI receiving centers (SRC) throughout the county. Since 2010, county-wide protocols mandate transport of all OOHCA patients of presumed cardiac etiology with return of spontaneous circulation (ROSC) in the field to a SRC with an established hypothermia protocol. All SRCs treating ROSC patients report the in-hospital mortality and neurologic outcome of these patients to a single registry maintained by the LA County Emergency Medical Services Agency. We report the preliminary results of the first 8 months after this policy change, with the primary outcome variable of neurologically intact survival at hospital discharge, as defined by a Cerebral Performance Category (CPC) score upon hospital discharge of 1 or 2. Results: There were 663 patients with field ROSC reported by the SRCs. Of these, 110 (17%) died in the emergency department (DOA), and 66 (10%) were awake and responsive upon hospital arrival, leaving 487 patients included in the study analysis. Of these patients, VF was the initial rhythm in 143 (29%), of whom 36 (25%) survived to hospital discharge (SHD) with a CPC score of 1 or 2. 108 (76%) patients with shockable rhythms received therapeutic hypothermia (TH), of whom 32 (30%) had neurologically intact SHD. In the TH group, the OR for CPC 1 or 2 in patients with an initial shockable rhythm was 3.3 (95%CI 1.1-9.5, p = .04), compared with those who did not received TH. In contrast, the SHD rate in Los Angeles in 2001 for a witnessed arrest with a shockable rhythm was 6%. Conclusion: These results suggest that regionalization of post-resuscitation care improves the rate of neurologically intact survival from OOHCA.