Critical Care |

Post Cardiac Arrest: Where Do You Need to Be? Coronary Care Unit (CCU) Vs Medical Intensive Care Unit (MICU) FREE TO VIEW

Parth Rali, MD; Win Naing, MD
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Allegheny General Hospitali, Pittsburgh, PA

Chest. 2014;145(3_MeetingAbstracts):195A. doi:10.1378/chest.1822044
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SESSION TITLE: Critical Care Posters I

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Cardiac arrest patients are often admitted to CCU/MICU depending on academic setting. We aimed to compare outcomes of cardiac arrest patients based on demographics of the patients admitted to CCU Vs MICU. We also tried to identify role of hypothermia in different type underlying arrest rhythms

CASE PRESENTATION: Methods: Retrospective Data was collected from January 2011 and January 2012 at Elmhurst Hospital Center which is Level I Trauma hospital in New York City with 17 ICU beds. Inclusion Criteria: All patients with cardiac arrest both in hospital and out of hospital arrest, admitted to CCU or MICU. Admission to CCU Vs MICU was determined by Emergency Department. Decision of Hypothermia was decided by CCU and MICU team. Exclusion Criteria: a) patients without documented rhythm b) all patients with missing documentations c) all patient admitted to Step Down ICU with poor prognosis rejected by ICU d) patients admitted to other ICUs because of lack of beds

DISCUSSION: Results: Electronic Charts were reviewed for 58 patients, 7 patients were excluded and data was analyzed for 51 patients. Out of 51, 18 were admitted to CCU and 33 to MICU. Survival rate was 72% vs 30% in CCU and MICU respectively. 89% of CCU patients received hypothermia and out of those 69% survived compared to 72% and 17% respectively. Majority of CCU population comprised of Ventricular Fibrillation (Vfib) rhythm compared to MICU population asystole or Pulse electrical activity (PEA). MICU patients had significantly Longer Length of Stay (LOS), Days of Mechanical Ventilation and tracheostomy rate and relatively higher APACHE II score. Home return was much higher in CCU patients than MICU patients. Hypothermia had the greatest benefit in survival rates if underlying rhythm was Vfib arrest Vs PEA/Asystole. Average Return to Spontaneous Circulation (ROSC) time in patients who survived was 12 minutes vs 24 minutes who did not survive. Drawback: A)Retrospective data, B) Relatively small sample size, C) No long term follow up, D) Single center observational study Future direction: A)Increasing power of study, B) Adding follow up outcome with IRB approval

CONCLUSIONS: Patients admitted to CCU had better survival rate, home returning rate, less LOS and Ventilator dependent day. The majority of the patients admitted to CCU had Vfib as underlying rhythm compared to PEA/Asystole in MICU patients. Greatest benefit of therapeutic hypothermia was seen in patients with Vfib than PEA/Asystole, with inverse survival relationship noticed if presenting rhythm was asystole.

Reference #1: Circulation. 2003; 108: 118-121

DISCLOSURE: The following authors have nothing to disclose: Parth Rali, Win Naing

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