Author + information
- Received May 17, 2018
- Revision received June 7, 2018
- Accepted June 13, 2018
- Published online September 17, 2018.
- Muharrem Akin, MDa,∗,
- Jan-Thorben Sieweke, MDa,∗,
- Florian Zauner, MDa,
- Vera Garchevaa,
- Jörn Tongers, MDa,
- L. Christian Napp, MDa,
- Lars Friedrich, MDb,
- Jens Treptau, MDa,
- Max-Udo Bahntjea,
- Ulrike Flierl, MDa,
- Daniel G. Sedding, MDa,
- Johann Bauersachs, MDa and
- Andreas Schäfer, MDa,∗ ()
- aCardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- bDepartment of Anaesthesiology, Hannover Medical School, Hannover, Germany
- ↵∗Address for correspondence:
Dr. Andreas Schäfer, Hannover Medical School, Department of Cardiology and Angiology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Objectives This study sought to analyze the impact of mandatory therapeutic hypothermia and cardiac catheterization in the absence of overt noncardiac cause of arrest as part of the Hannover Cardiac Resuscitation Algorithm before intensive care admission.
Background Despite advanced therapies, out-of-hospital cardiac arrest (OHCA) is still associated with high mortality rates. Recently, the TTM (Target Temperature Management 33°C Versus 36°C After Out-of-Hospital Cardiac Arrest)-trial caused severe uncertainty about the efficacy of and need for therapeutic hypothermia. Furthermore, the role of early coronary angiography in OHCA survivors without ST-segment elevation remains undetermined.
Methods In the HACORE (HAnnover Cooling REgistry) we investigated 233 consecutive patients (median age 64 [interquartile range: 53 to 74] years) with OHCA admitted to our institution between January 2011 and December 2015 who were treated according to the algorithm.
Results A total of 73% had ventricular fibrillation as primary rhythm. Return of spontaneous circulation was achieved after 20 (interquartile range: 10 to 30) min. Immediate percutaneous coronary angiography was performed in 96% and coronary angioplasty in 59% of all cases. ST-segment elevation was present in 47%. Critical coronary stenosis requiring percutaneous coronary intervention was present in 67% of patients with and 52% of patients without ST-segment elevation. Overall 30-day intrahospital mortality in this real-world registry was 37%. Patients in our local registry who matched the inclusion/exclusion criteria of the TTM-trial (n = 145) had a markedly lower 30-day mortality (27%) compared with the published trial (44%).
Conclusions Standardized treatment of patients with OHCA following a strict protocol incorporating computed tomography, cardiac catheterization and revascularization, liberal use of active hemodynamic support in presence of shock, and mandatory therapeutic hypothermia results in mortality rates lower than previously reported.
- cardiac arrest
- cardiopulmonary resuscitation
- coronary angiography
- targeted temperature management
- therapeutic hypothermia
↵∗ Drs. Akin and Sieweke contributed equally to this manuscript.
This study was supported by the Deutsche Forschungsgemeinschaft, Klinische Forschergruppe 311, TP1. Dr. Schäfer has received lecture fees from ZOLL Inc. and Abiomed and a research grant from Abiomed. Dr. Napp has received lecture fees from ZOLL Inc., Abiomed, and Maquet. Dr. Tongers has received lecture fees from Abiomed. Dr. Bauersachs has received lecture fees from Abiomed; and a research grant from Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 17, 2018.
- Revision received June 7, 2018.
- Accepted June 13, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.