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Abstract
Background. Post-resuscitation care of cardiac arrest patients at specialized centers may improve outcome after out-of-hospital cardiac arrest (OOHCA). This study describes experience with regionalized care of resuscitated patients. Methods. Los Angeles (LA) County established regionalized cardiac care in 2006. Since 2010, protocols mandate transport of nontraumatic OOHCA patients with field return of spontaneous circulation (ROSC) to a STEMI Receiving Center (SRC) with a hypothermia protocol. All SRC report outcomes to a registry maintained by the LA County Emergency Medical Services (EMS) Agency. We report the first year's data. The primary outcome was survival with good neurologic outcome, defined by a Cerebral Performance Category (CPC) score of 1 or 2. Results. The SRC treated 927 patients from April 2011 through March 2012 with median age 67; 38% were female. There were 342 patients (37%) who survived to hospital discharge. CPC scores were unknown in 47 patients. Of the 880 patients with known CPC scores, 197 (22%) survived to hospital discharge with a CPC score of 1 or 2. The initial rhythm was VF/VT in 311 (34%) patients, of whom 275 (88%) were witnessed. For patients with an initial shockable rhythm, 183 (59%) survived to hospital discharge and 120 (41%) had survival with good neurologic outcome. Excluding patients who were alert or died in the ED, 165 (71%) patients with shockable rhythms received therapeutic hypothermia (TH), of whom 67 (42%) had survival with good neurologic outcome. Overall, 387 patients (42%) received TH. In the TH group, the adjusted OR for CPC 1 or 2 was 2.0 (95%CI 1.2–3.5, p = 0.01), compared with no TH. In contrast, the proportion of survival with good neurologic outcome in the City of LA in 2001 for all witnessed arrests (irrespective of field ROSC) with a shockable rhythm was 6%. Conclusion. We found higher rates of neurologically intact survival from OOHCA in our system after regionalization of post-resuscitation care as compared to historical data.
Los Angeles County STEMI Receiving Centers
Beverly Hospital, Montebello, CA
Cedars Sinai Medical Center, Los Angeles, CA
Citrus Valley Medical Center–Intercommunity Campus, Covina, CA
Garfield Medical Center, Monterey Park, CA
Glendale Adventis Medical Center, Glendale, CA
Glendale Memorial Hospital and Health Center, Glendale, CA
Good Samaritan Hospital, Los Angeles, CA
Harbor–UCLA Medical Center, Torrance, CA
Hollywood Presbyterian Medical Center, Los Angeles, CAa
Huntington Memorial Hospital, Pasadena, CA
LAC + USC Medical Center, Los Angeles, CA
Lakewood Regional Medical Center, Lakewood, CA
Long Beach Memorial Medical Center, Long Beach, CA
Los Robles Hospital and Medical Center, Thousand Oaks, CA
Methodist Hospital of Southern California, Arcadia, CA
Northridge Hospital, Northridge, CA
Palmdale Regional Medical Center, Lancaster, CA
Pomona Valley Hospital Medical Center, Pomona, CA
Presbyterian Intercommunity Hospital, Whittier, CA
Providence Holy Cross Medical Center, Mission Hills, CA
Providence Little Company of Mary Medical Center, Torrance, CA
Providence Saint Joseph Medical Center, Burbank, CA
Providence Tarzana Medical Center, Tarzana, CA
Ronald Reagan UCLA Medical Center, Los Angeles, CA
San Antonio Community Hospital, San Antonio, CA
Santa Monica–UCLA Medical Center, Santa Monica, CA
St. John's Hospital and Health Center, Santa Monica, CA
St. Jude Medical Center, Fullerton, CA
St. Mary Medical Center, Long Beach, CA
Torrance Memorial Medical Center, Torrance, CA
Valley Presbyterian Hospital, Van Nuys, CA
West Hills Hospital and Medical Center, West Hills, CA
White Memorial Medical Center, Los Angeles, CA
Notes
aNewly approved in 2012.