Emergency Department Survival After OHCA

Written by Aaron Lacy

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In patients who suffer non-traumatic out-of-hospital-cardiac arrest (OHCA) and are transferred to the ED, there is a wide range of survivability. Those taken to centers with 24/7 interventional cardiology and a higher number of OHCAs per year had a greater chance of ED survival.

?Why does this matter
Prior to this article there was little published on presenting characteristics and outcomes in patients who suffered OHCA and were transported to an ED. Only 12% of patients who suffered OHCA survived to discharge. A better understanding of the patient, hospital, and system-level characteristics associated with survival could serve as a starting point for quality and process improvement.

?My patient is coding – where to next
This retrospective study obtained data from the Victorian (Australia) Ambulance Cardiac Arrest Registry on patients (n=1,547) who suffered non-traumatic OHCA and presented to 12 different adult hospitals. Patients were excluded if they were pronounced dead immediately upon arrival. 81% of patients had an identifiable cause of their arrest, with 58% of all cases being cardiac. 81% had bystander-CPR, and 74% of patients arrived with ROSC. Patients with resuscitation efforts terminated in the field by local protocol were excluded. Patients taken to hospital centers deemed “high status” (24/7 PCI, 51-112 OHCA per year) had significantly greater ED survival (aOR 3.43, 95%CI 1.89-6.21, P < 0.001).

This 21-page paper had a lot more data and information to digest. We know that any cardiac arrest is bad (duh), and meaningful survival chances are not good. There are many, often conflicting, things that seem to affect survival in the prehospital setting.

My big takeaways from this article are:

All-comer OHCA has very low survival rates, but those who do make it to the ED have a higher chance of survival to hospital discharge (n=658, 43%).

If the patient arrives with a pulse, or you get ROSC in the ED, there is still a high chance of a rearrest in the ED (20%). This number is likely to go up as hospital capacity issues increase – so stay on guard.

Practice really does make perfect – the more your center deals with this, the better a patient’s chance of survival.

There are many studies looking at treatment interventions that affect survival rate in cardiac arrest, but we need to take a step back and review things from a system level more often so we can provide system level interventions to help out patients.

Source
Out-of-hospital cardiac arrest outcomes in emergency departments. Resuscitation. 2021 Jul 13;S0300-9572(21)00251-3. doi: 10.1016/j.resuscitation.2021.07.003. Online ahead of print.

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