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Our hypothesis is that in a large tertiary Hospital in London the door to balloon time (DBT) should decrease with the introduction of a multidisciplinary coordinated heart attack team (HAT) designed to deliver out of hospital cardiac arrest (OHCA) patients directly to the cardiac catheter laboratories, bypassing the emergency department.
This is a retrospective observational study looking at the outcome of consecutive OHCA patients of presumed cardiac origin presenting directly to our institution over a period of 3 years. The HAT was introduced in 2011 and so it was possible to compare data before (26 months) and with the HAT in place (14 months after). We focused on DBT, survival, length of stay (LOS) in the intensive care unit (ICU) and in hospital and neurological status on hospital discharge using the cerebral performance category scale. Data were derived from hospital notes, electronic records and ambulance sheets.
A total of 45 OHCA patients were admitted to ICU having had successful emergency percutaneous coronary intervention. 33 patients were male (77.8%), median age 60 years [IQR 18 years] and 57.8% survived to hospital discharge with only 3 patients (6.7%) having a poor neurological outcome (cerebral performance category 3). Before the introduction of the HAT, there were 17 OHCA patients who had successful emergency percutaneous coronary intervention. The median DBT was 104 minutes [IQR 94 minutes]. Survival to hospital discharge was 8/17 (47.1%) with a median ICU LOS for survivors of 9.2 days [IQR 7.2 days], LOS in hospital 11 days [IQR 16 days]. After the introduction of the HAT, 28 patients were admitted for percutaneous coronary intervention with median DBT 49 minutes [IQR 32 minutes]. Survival to hospital discharge was 18/28 (64.3%) with a median ICU LOS for survivors of 3.9 days [IQR 6.4], LOS in hospital 10 days [IQR 10 days]. The DBT was reduced with the introduction of the HAT (p<0.005) with a trend for improved survival, reduced LOS on ICU and reduced LOS in hospital.
The DBT was reduced with the introduction of the HAT which we believe could become a significant predictor for survival in OHCA patients.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Improving Outcomes in Cardiac Arrest and Resuscitation
Abstract Category: 22. Performance Improvement
Presentation Number: 1262-271
- 2013 American College of Cardiology Foundation