Poster Presentations / Resuscitation 84S (2013) S8–S98 S83

soon enough. All patients receiving cooling should do so in theEmergency Department as soon as there is return of output. Thereneeds to be stricter timing and temperature control. This is hope-fully all to be achieved by more intense staff education with are-audit in 2 years.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.209

AP184

Survival and quality of life after cardiac arrest

Daniel Coutinho ∗, Ana Paixão, Carla Nogueira,Paula Castelões

Centro Hospitalar de Vila Nova de Gaia/Espinho, VilaNova de Gaia, Portugal

Purpose: The purpose of this study was to evaluate the healthstatus outcomes of patients who presented a cardiac arrest within-hospital or out-of-hospital cardiopulmonary resuscitation (CPR)and were admitted to an Intensive Care Unit (ICU).

Methods: From 2005 to 2011, all 24-h cardiac arrest survivorsthat were admitted to a twelve-bed medical/surgical ICU of a gen-eral hospital were included. Data was collected from records ofthe out-of-hospital and in-hospital emergency teams and frompatient’s records. Health-related quality-of-life was assessed sixmonths after ICU discharge with EQ-5D questionnaire. We usedPearson chi-square test for analysis of categorical data and Mann-Whitney test for continuous variables. Statistical significance wasat p < 0.05.

Results: Seventy-one patients were included in the study. Sixty(84.5%) patients had a witnessed collapse, with 13 (18.3%) ofthose patients presenting VT/VF as initial rhythm. Forty-seven(66.2%) CPR occurred in-hospital. Mortality was significantly lowerin those patients (p = 0.006). Fifty-one patients (71.8%) were dis-charged from ICU. Of these, 19 patients died in the ward. Thirty-two(45.1%) patients were discharged from hospital. Two patients diedafter hospital discharge but before 6-month evaluation. Eighteenpatients were lost to follow-up, three because they were living indistant locations; other three were institutionalized outside hos-pital’s area of influence and twelve for unknown reasons. Twelvepatients attended the follow-up consultation. One of these patientswas actively working, two were unemployed and nine patientswere retired. Overall, ten patients had managed to return to theirprevious activity. Median EQ-5D VAS was 65%, although threepatients presented extreme problems in at least one of the fivedimensions and four perceived a worse current health state.

Conclusion: In-hospital CPR is usually more successful than aCPR in an out-of-hospital environment. Nevertheless, CPR is fre-quently unsuccessful, but when survival is achieved a fairly goodquality of life can be expected.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.210

AP185

What is optimal blood pressure in patientsinitially surviving an out-of-hospital cardiacarrest event?

Janet Bray 1,∗, Kate Cantwell 2, Stephen Bernard 3,Michael Stephenson 2, Karen Smith 4

1 Monash University, Melbourne, Australia2 Ambulance Victoria, Melbourne, Australia3 Ambulance Victoria, Monash University, AlfredHospital, Melbourne, Australia4 Ambulance Victoria, Monash University, Universityof Western Australia, Perth, Australia

The purpose of the study: The optimal blood pressure targetin patients with return-of-spontaneous-circulation (ROSC) follow-ing resuscitation from out-of-hospital cardiac arrest (OHCA) isuncertain. This study aimed to determine the relationship betweensystolic blood pressure (SBP) on arrival at hospital and survival tohospital discharge.

Methods: A retrospective review was conducted using databetween 2003 and 2012 from the Victorian Ambulance CardiacArrest Register (VACAR). Inclusion criteria were: adults (≥18 years),OHCA of presumed cardiac etiology, not paramedic witnessed,and pulse present on hospital arrival. Adjusted logistic regressionmodels stratified by initial monitored rhythm (shockable and non-shockable) were performed to examine the relationship betweenSBP at hospital arrival in 10 mmHg increments and outcome. Themodels were adjusted for factors known to predict survival, includ-ing duration of attempted EMS resuscitation.

Results: There were 3620 OHCA eligible cases. Median agewas 69 years (IQR = 20), 70% were male, and 60% in a shock-able rhythm on ambulance arrival. Hypotension (SBP < 90 mmHg)at hospital was reported in 14% (10% in shockable and 19%in non-shockable rhythms). For patients initially in a shockablerhythm, survival was maximal at 120–129 mmHg (54%) and in theadjusted model (using ≥120 mmHg as reference) became signifi-cantly associated with mortality at increments below 90 mmHg:SBP 80–89 mmHg AOR = 0.49 (95%CI: 24–0.95); SBP <79 mmHgAOR = 0.24 (95%CI: 0.10–0.61); unrecordable SBP AOR = 0.10 (95%CI0.04–0.30). In patients found in a non-shockable rhythm, the rela-tionship between arrival SBP and survival was linear, but was notsignificant after duration of the arrest was added to the model.

Conclusions: In an EMS system using intravenous adrenalineand fluids to achieve and/or maintain post-ROSC SBP >120 mmHg,SBP ≥90 mmHg on arrival to hospital was independently associatedwith increased survival in patients found in a shockable rhythm.This level may indicate patients who require more aggressive post-resuscitation blood pressure management.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.211

AP186

Outcomes of patients admitted to the IntensiveCare Department following cardiac arrest

Emma Everitt 1,2

1 Pennine Acute Trust, Greater Manchester, UK2 North Western Deanery, North West, UK

Objectives and background: Patients who suffer cardiac arrestsuffer high mortality and morbidity rates: a significant cause beinganoxic brain injury. Patients deemed suitable candidates who suc-cessfully regain a return of spontaneous circulation are admitted tothe intensive care unit (ICU) for therapeutic hypothermia. I wanted

S84 Poster Presentations / Resuscitation 84S (2013) S8–S98

to look at the outcomes of those admitted to the ICU and com-pare the results of those who were cooled to those who werenot. Although out of hospital shockable rhythm arrests are rou-tinely cooled there is still a culture of not cooling some patientswho present with non-shockable rhythms and those who arrest inhospital.

Methods: This is a retrospective observational study where Ilooked at the notes of 35 patients admitted to the ICU at NorthManchester General Hospital following a cardiac arrest over a 23month period.

Results: Cooled patients had a lower 30 day mortality rate(44.4%) than those who did not receive therapeutic hypothermia(58.8%) and also had a reduced morbidity rate: 6 out of 10 sur-vivors were reported as getting back to baseline compared to 3 outof 7 in the normothermic group. Length of stay in ICU and hospitalwas shorter in the hypothermic group. 40% of the patients in thenormothermic group who died in the 30 days following arrest hadhypoxic brain injury listed as the cause. 5 out of 18 patients hadcomplications of cooling documented however only 1 had coolingabandoned.

Conclusion: Although mortality and morbidity following a car-diac arrest is multifactorial, the patients who received therapeutichypothermia achieved lower mortality and morbidity rates thanthose who were normothermic suggesting that all patients who areadmitted following cardiac arrest who do not meet the exclusioncriteria of the local policy should be considered for cooling.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.212

AP187

Vasopressor support in therapeutichypothermia after out-of-hospital cardiacarrest: Prognostic implications

John Bro-Jeppesen 1,∗, Jesper Kjaergaard 1, HelleSøholm 1, Michael Wanscher 2, Freddy Lippert 3,Jacob Møller 1, Lars Køber 1, Christian Hassager 1

1 Department of Cardiology, The Heart Centre,Copenhagen University Hospital Rigshospitalet,Copenhagen, Denmark2 Department of Anaesthesia, The Heart Centre,Copenhagen University Hospital Rigshospitalet,Copenhagen, Denmark3 Emergency Medical Services, The Capital Region ofDenmark, Copenhagen, Denmark

Purpose of the study: Inducing therapeutic hypothermia (TH)in survivors after out-of-hospital cardiac arrest (OHCA) can bechallenging due to its impact on central hemodynamics and vaso-pressors are frequently used to counteract hypotension and tomaintain adequate organ perfusion. The purpose of this study wasto assess the prognostic implication of level of vasopressor supportand mortality during and after TH.

Materials and methods: In the period 2004–2010, a total of 310consecutive comatose patients admitted after OHCA and treatedwith a target temperature of 32–34 ◦C were included. Tempera-ture, hemodynamic parameters and types of vasopressors wereregistered on an hourly basis from admission to 24 h after rewarm-ing. The population was stratified by a simplified vasopressor scoredefined by use of no or 1 vasopressor (low vasopressor group)or need for >1 vasopressors (high vasopressor group) during thestudy period. Primary endpoint was 30-days all-cause mortalityand secondary endpoint was death from neurological injuries withcardiovascular deaths being censored at time of death. Follow-upwas 100% complete.

Results: Overall 99.7% of patients were treated with at least onevasopressor and 44% were treated with >1 vasopressor during orafter TH. There were no differences in demographics or pre-hospitaldata between the two vasopressor groups. Patients in the high vaso-pressor group carried a 49% 30-days mortality rate compared to 23%in the low vasopressor group, plog-rank < 0.0001, corresponding to anadjusted hazard ratio (HR) of 2.0 (95% CI: 1.3–3.0), p = 0.001). Useof >1 vasopressor was associated with increased 30-days mortalitydue to neurological injuries (HR = 1.7 (95% CI: 1.1–2.7), p = 0.02).

Conclusions: Vasopressors were frequently used as hemo-dynamic support during and after TH. Despite similar baselinecharacteristics, patients treated with more than 1 vasopressor hadincreased all-cause mortality and increased mortality due to neu-rological injuries.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.213

Prevention of Cardiac Arrest

AP188

Early recognition of the deteriorating patientand calling for help—Does it decrease thenumber of cardiac arrest calls?

Yassar Mustafa ∗, Carol Downing

Queen Elizabeth Hospital, Birmingham, UK

Purpose: The first chain in the well-established AdvancedLife Support protocol published by the UK Resuscitation Coun-cil is recognising the deteriorating patient early and calling themedical emergency team. With the introduction of mandatorytrust-provided Advanced Life Support courses for all junior doctorsprior to starting posts at a large teaching hospital wherein callingfor help early is now strongly emphasised, we conducted a studyto assess whether this intervention has affected the frequency ofcalls made to the medical emergency team for cardiac arrests orperi-cardiac arrests.

Methods: We undertook a retrospective study investigatingpost-cardiac arrest surveys from the past five years at a large uni-versity teaching hospital that incorporates a level 1 trauma centreand tertiary cardiac unit. Specifically, we assessed the number ofcardiac arrest calls and compared them to the number of peri-arrestcalls made to the medical emergency team in each year of the studyperiod.

Results: The mean annual number of cardiac arrest calls madefrom 2008 to 2011 was 225.25 (SD 29.5), while the mean annualnumber of peri-arrest calls made in the same period was 126.5(SD 32.2). After the mandatory Advanced Life Support training, thenumber of cardiac arrest calls made in 2012 was 137, while thenumber of peri-arrest calls made was 155. That represents a changein the ratio of cardiac arrest to peri-cardiac arrest call out from 1.78prior to the mandatory training to 0.88 after its introduction.

Conclusions: Our results clearly show that ensuring everyjunior doctor has undertaken the Advanced Life Support trainingthat emphasises calling for help early significantly reduces cardiacarrest-associated mortality. Further studies can be conducted inorder to look at survival rates from both cardiac and peri-cardiacarrest calls.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.214