Successful Implementation of Comprehensive Packages of Postcardiac Arrest Care After Out-of-Hospital Cardiac Arrest: A Single Institution Experience in South Korea.

Abstract

The survival rate among patients admitted to hospital after out-of-hospital cardiac arrest (OHCA) was generally poor. And the optimal hospital care for patients after OHCA is not exactly known because multiple organ systems are affected. We implemented comprehensive packages of postcardiac arrest care, including therapeutic hypothermia (TH) to improve outcomes in patients with successfully resuscitated from OHCA. All patients with OHCA from January 2009 to September 2010 (intervention period) were included and compared to controls from January 2006 to December 2007 (control period). An adjusted analysis was performed using multivariate regression to test association of outcomes with the package. During the intervention period, 168 patients were brought to the emergency department, 76 patients regained spontaneous circulation, and 41 patients were eligible for TH. Of these 41 patients, 36 (87.8%) ultimately achieved temperatures of <34°C. During the control period, 149 patients were brought to the emergency department, 57 patients regained spontaneous circulation, and 35 patients were eligible for TH. Of these 35 patients, 4 (11.4%) ultimately achieved temperatures of <34°C. In the adjusted analysis, patients admitted during the intervention period demonstrated improved survival (odds ratio: 2.609, 95% confidence interval: 1.318-5.166) and had favorable neurologic outcomes (odds ratio: 3.568, 95% confidence interval: 1.224-10.399) compared with those admitted during the control period. Comprehensive packages of postcardiac arrest care can be successfully implemented in a tertiary teaching hospital. In addition, implementation of TH was associated with significant improvements in survival and neurologic outcomes after OHCA.