Authors: Kocjancic ST et al., Resuscitation 2014 Jul 7;
Although intensified postresuscitation care was associated with improved outcome overall, in patients with shockable rhythms, early PCI was the only advanced intervention that was independently associated with improved outcome.
Using a cardiac arrest registry in Slovenia, researchers compared outcomes between comatose survivors of nontraumatic cardiac arrest with both shockable and nonshockable initial rhythms during two periods: conservative treatment (1995 to 2003; 274 patients) and intensified treatment (2004 to 2012; 551 patients).
Use of interventions increased from the conservative- to intensified-care periods. Among 580 patients with shockable rhythms, use of therapeutic hypothermia increased from 1% to 93%; immediate invasive coronary interventions from 28% to 78%; intraaortic balloon pump from 4% to 21%; vasopressor/inotropes from 47% to 81%; and antibiotic administration from 65% to 86%. During this period, neurologically favorable survival increased from 27% to 47%. After adjustment for confounders, only immediate percutaneous coronary intervention (PCI) and use of antimicrobial agents were associated with improved neurologically favorable survival. Among patients with nonshockable rhythms, neurologically favorable survival did not change significantly between the two periods (7% and 9%), but after adjustment for confounders, antimicrobial use was associated with improved neurologically favorable survival.
The authors suggest that prehospital patients with initial shockable rhythms who remain comatose after resuscitation should be transported directly to centers with immediate capability for these intensified interventions, but their own results do not support this. PCI may be valuable for some patients, but the evidence regarding antibiotic use here is tenuous, at best; no other intervention was associated with any outcome improvement.