Early coronary angiography and induced hypothermia are associated with survival and functional recovery after out-of-hospital cardiac arrest

Background: The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (<= 24 h after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA. Methods: We performed a secondary analysis of a multicenter clinical trial (NCT00394706) conducted between 2007 and 2009 in 10 North American regions. Subjects were adults (>= 18 years) hospitalized after OHCA with pulses sustained >= 60 min. We measured the association of early coronary catheterization, percutaneous coronary intervention, fibrinolysis, and induced hypothermia with survival to hospital discharge with favorable functional status (modified Rankin Score <= 3). Results: From 16,875 OHCA subjects, 3981 (23.6%) arrived at 151 hospitals with sustained pulses. 1317 (33.1%) survived to hospital discharge, with 1006 (25.3%) favorable outcomes. Rates of early coronary catheterization (19.2%), coronary reperfusion (17.7%) or induced hypothermia (39.3%) varied among hospitals, and were higher in hospitals treating more subjects per year. Odds of survival and favorable outcome increased with hospital volume (per 5 subjects/year OR 1.06; 95% CI: 1.04-1.08 and OR 1.06; 95% CI: 1.04, 1.08, respectively). Survival and favorable outcome were independently associated with early coronary angiography (OR 1.69; 95% CI 1.06-2.70 and OR 1.87; 95% CI 1.15-3.04), coronary reperfusion (OR 1.94; 95% CI 1.34-2.82 and OR 2.14; 95% CI 1.46-3.14), and induced hypothermia (OR 1.36; 95% CI 1.01-1.83 and OR 1.42; 95% CI 1.04-1.94). Interpretation: : Early coronary intervention and induced hypothermia are associated with favorable outcome and are more frequent in hospitals that treat higher numbers of OHCA subjects per year. (C) 2014 Elsevier Ireland Ltd. All rights reserved.