Background: Prior to July 2015, our tertiary care hospital had no protocol to manage in-hospital treatment of patients resuscitated from ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). We subsequently designed a formal protocol to guide management of these patients. We then retrospectively evaluated patient outcomes to assess the clinical impact of this protocol.
Methods: Only patients with an initial shockable rhythm were included in this analysis. The protocol specified patients with ST-segment elevation myocardial infarction (STEMI) would be admitted to the cardiac catheterization lab within 90 minutes and then admitted to the cardiovascular intensive care unit (CVICU). Uncomplicated patients without STEMI were admitted to the CVICU. All other patients were admitted to the medical intensive care unit (MICU) without cardiac catheterization. Patients were classified into 2 groups: 1) pre-protocol (June 2013 - June 2015), or 2) post-protocol (May 2016 - March 2017). Transfers from an outside hospital or non-cardiac arrests, including drug overdose, pulmonary embolism, and trauma were excluded. Endpoints included survival to hospital discharge, functionally favorable survival (Cerebral Performance Category (CPC) 1 or 2), initial admission to the CVICU versus MICU, and cardiac catheterization at sometime during hospital admission. Statistical analysis was completed using Fisher's exact test. The Institution Review Board at the Medical College of Wisconsin approved this study.
Results: Fifteen patients were analyzed in the pre-protocol group and 20 patients in the post-protocol group. The survival rate to hospital discharge was significantly improved in the post-protocol group compared to the pre-protocol group (65% (95%CI 0.45-0.85) vs 20% (95%CI 0-0.4), respectively, p=0.02). Significantly more patients were admitted to the CVICU in the post-protocol group compared to the pre-protocol group 95% (95%CI 0.82-1) vs 53% (95%CI 0.3-0.76), respectively, p=0.01). The number of patients receiving cardiac catheterization also increased in the post-protocol group compared to the pre-protocol group (75% vs 40%, p=0.08).
Conclusion: Outcomes improved after the introduction of our protocol to guide management of patients with OHCA.