Document Detail


Cardiac catheterization is underutilized after in-hospital cardiac arrest.
MedLine Citation:
PMID:  18951683     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival.
METHODS: Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using Chi-square, and adjusted analyses were performed using logistic regression.
RESULTS: One hundred and ten in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within 1 day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, p<.05).
CONCLUSION: In patients receiving cardiac catheterization, more than half received this procedure for indications other than STEMI or new LBBB. Cardiac catheterization was associated with improved survival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.
Authors:
Raina M Merchant; Benjamin S Abella; Monica Khan; Kuang-Ning Huang; David G Beiser; Robert W Neumar; Brendan G Carr; Lance B Becker; Terry L Vanden Hoek
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-10-31
Journal Detail:
Title:  Resuscitation     Volume:  79     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-08     Completed Date:  2009-03-10     Revised Date:  2011-06-15    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  398-403     Citation Subset:  IM    
Affiliation:
The Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, United States. raina.merchant@uphs.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Female
Heart Arrest / therapy*
Heart Catheterization / utilization*
Hospitalization*
Humans
Male
Middle Aged
Retrospective Studies
Ventricular Fibrillation / therapy
Grant Support
ID/Acronym/Agency:
UL1 RR024999-01/RR/NCRR NIH HHS
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