German Cardiac Arrest Registry (G-CAR): results of the pilot phase

Abstract

Abstract Background/Introduction In Europe, over 30.000 persons per year suffer from out-of-hospital cardiac arrest (OHCA). Despite medical progress, survival rates with good neurological outcome remain low. For many important clinical issues, no or only insufficient evidence from randomised trials is available. Therefore, a systemic and standardised acquisition of the treatment course and of the outcome of OHCA patients is warranted. Purpose The German Cardiac Arrest Registry (G-CAR) is an observational, prospective, multicentre registry under the aegis of the German National Cardiac Society. It determines the characteristics, initial treatment strategies, invasive procedures, revascularisation therapies and the use of mechanical circulatory support devices with a focus on extracorporeal cardiopulmonary resuscitation (eCPR). It includes a prospective 12-month follow-up evaluating mortality, neurological outcomes and several patient-reported outcomes in the psychosocial domain, figure 1. Herein, we describe the first results of the pilot phase; more data will be available at the time of the ESC congress. Methods and Results In a pilot phase of 16 months, 15 national centres included 480 consecutive OHCA patients ≥18 years. Median age of the patients was 67 (interquartile range 57;76) years, 74.4% were male. 77.5% of the events were witnessed; bystander CPR was performed in 77.4%. Initial rhythm was shockable in 46.5%. 28.5% of the patients had ongoing CPR at hospital admission. eCPR was performed in 14.1% of the patients. Main presumed underlying causes of CPR were acute coronary syndromes and/or cardiogenic shock in 53.3% followed by primary arrhythmias (7.9%) and hypoxia (5.2%). In 35.2%, ST-segment elevations were observed after return of spontaneous circulation, mostly (62.1%) with an anterior location. In total, 66.6% of the patients underwent coronary angiography. In 71.5%, angiography was performed immediately, in 23.8% within 24 hours and in 4.7% in an elective setting. The LAD was the culprit lesion in 35.8%, the RCA in 17.7%, the LCX in 10.6% and the LM in 5.1%. In 30.3%, there was either no or an unclear culprit lesion. Regarding the strategy of percutaneous coronary intervention (PCI), culprit-only PCI was performed in 74.5%, multivessel PCI in 25.5%. Targeted temperature management was performed in 79.8%, with an invasive approach and non-invasive approach in approximately 50% each. In-hospital mortality was 69.2%, with anoxic brain damage being the main presumed cause of death (37.3%) followed by circulatory failure in 26.2%. Conclusions G-CAR is a multicenter German registry for adult OHCA patients including long-term follow-up. Primary aim is a better understanding of the determinants of acute and long-term outcomes with the perspective of an optimised treatment. Parallel to further in-depth analyses of the pilot phase including patient-reported outcomes, scaling up of G-CAR to a national level is envisaged.Registry flow-chartFirst results pilot phase G-CAR