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Accredited cardiac arrest centers facilitate eCPR and improve neurological outcome
Fabian Voß1, Tharusan Thevathasan2, Karl Heinrich Scholz3
1Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany.
Insights
Cardiac Arrest Centers (CACs) in Germany improved neurological outcomes for out-of-hospital cardiac arrest (OHCA) survivors. While overall survival rates remained unchanged, CAC accreditation led to better patient recovery.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Out-of-hospital cardiac arrest (OHCA) has low survival rates.
- Dedicated teams and specialized centers are recommended to improve prognosis.
- Cardiac Arrest Centers (CACs) were introduced in Germany following 2015 guidelines.
Purpose of the Study:
- To evaluate the impact of newly established CACs in Germany.
- To assess effects on survival rates and neurological outcomes after OHCA.
- To compare patient outcomes before and after CAC accreditation.
Main Methods:
- Multicenter retrospective observational cohort study.
- Comparison of OHCA patient outcomes at three university hospitals.
- Analysis of survival until discharge and neurological status (CPC 1 or 2) at discharge.
Main Results:
- Increased rates of percutaneous coronary intervention (PCI) and extracorporeal CPR (ECPR) post-CAC accreditation.
- Higher likelihood of favorable neurological status at discharge after CAC accreditation (71% vs. 87%).
- Overall survival rates remained similar before and after CAC accreditation (35% vs. 35%).
Conclusions:
- CAC accreditation is associated with improved neurological outcomes.
- Overall survival rates were not significantly changed by CAC accreditation.
- Implementation of CACs enhances patient recovery post-OHCA.
Background:
Out-of-hospital cardiac arrest (OHCA) remains a frequent medical emergency with low survival rates even after a return of spontaneous circulation (ROSC). Growing evidence supports formation of dedicated teams in scenarios like cardiogenic shock to improve prognosis. Thus, the European Resuscitation Council (ERC) recommended introduction of Cardiac Arrest Centers (CAC) in their 2015 guidelines. Here, we aimed to elucidate the effects of newly introduced CACs in Germany regarding survival rate and neurological outcome.
Methods:
A multicenter retrospective observational cohort study was performed at three university hospitals and outcomes after OHCA were compared before and after CAC accreditation. Primary outcomes were survival until discharge and favorable neurological status (CPC 1 or 2) at discharge.
Results:
In total 784 patients (368 before and 416 after CAC accreditation) were analyzed. Rates of immediate percutaneous coronary intervention (40 vs. 52%, p = 0.01) and implementation of extracorporeal CPR (8 vs. 13%, p < 0.05) increased after CAC accreditation. Likelihood of favorable neurological status at discharge was higher after CAC accreditation (71 vs. 87%, p < 0.01), whereas overall survival remained similar (35 vs. 35%, p > 0.99).
Conclusion:
CAC accreditation is linked to higher rates of favorable neurological outcome and unchanged overall survival.
