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Quality of post arrest care does not differ by time of day at a specialized resuscitation center.

Uray T, Sterz F, Weiser C, Schreiber W, Spiel A, Schober A, Stratil P, Mayr FB - Medicine (Baltimore) (2015)

Bottom Line: In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36).Survival and good neurologic outcome at 12 months did not differ between day and night admissions.Our results may support the concept of specialized post arrest care centers.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine (TU, FS, CW, WS, Alexander Spiel, Andreas Schober, PS), Medical University of Vienna, Vienna, Austria; and CRISMA Center (FBM), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

ABSTRACT
Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.

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Kaplan–Meier curve for comparison of 12-month survival between daytime and nighttime admissions after out-of-hospital cardiac arrest. ROSC = return of spontaneous circulation.
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Figure 3: Kaplan–Meier curve for comparison of 12-month survival between daytime and nighttime admissions after out-of-hospital cardiac arrest. ROSC = return of spontaneous circulation.

Mentions: Survival after 12 months was similar in patients admitted during day and nighttime (49% and 48%, respectively, P = 0.94; Table 3 and Figure 3). The probability of survival at 12 months remained unchanged after adjusting for age, sex, initial rhythm, arrest location, and comorbid conditions (OR, 1.01; 95% CI, 0.76–1.31, P = 0.96 for daytime vs. nighttime admissions). Of all patients admitted, 441 (42%) had a favorable neurologic outcome at 12 months (43% for daytime admissions vs. 41% for nighttime admissions, P = 0.46). No patients were lost to follow up.


Quality of post arrest care does not differ by time of day at a specialized resuscitation center.

Uray T, Sterz F, Weiser C, Schreiber W, Spiel A, Schober A, Stratil P, Mayr FB - Medicine (Baltimore) (2015)

Kaplan–Meier curve for comparison of 12-month survival between daytime and nighttime admissions after out-of-hospital cardiac arrest. ROSC = return of spontaneous circulation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554053&req=5

Figure 3: Kaplan–Meier curve for comparison of 12-month survival between daytime and nighttime admissions after out-of-hospital cardiac arrest. ROSC = return of spontaneous circulation.
Mentions: Survival after 12 months was similar in patients admitted during day and nighttime (49% and 48%, respectively, P = 0.94; Table 3 and Figure 3). The probability of survival at 12 months remained unchanged after adjusting for age, sex, initial rhythm, arrest location, and comorbid conditions (OR, 1.01; 95% CI, 0.76–1.31, P = 0.96 for daytime vs. nighttime admissions). Of all patients admitted, 441 (42%) had a favorable neurologic outcome at 12 months (43% for daytime admissions vs. 41% for nighttime admissions, P = 0.46). No patients were lost to follow up.

Bottom Line: In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36).Survival and good neurologic outcome at 12 months did not differ between day and night admissions.Our results may support the concept of specialized post arrest care centers.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Emergency Medicine (TU, FS, CW, WS, Alexander Spiel, Andreas Schober, PS), Medical University of Vienna, Vienna, Austria; and CRISMA Center (FBM), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

ABSTRACT
Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.

Show MeSH
Related in: MedlinePlus