Successful out-of-hospital cardiopulmonary resuscitation: what is the optimal in-hospital treatment strategy?

The aim of the study was to evaluate prognostic factors in patients after s uccessful out-of-hospital resuscitation (sOHR) within 30 min after admissio n. A prognostic scoring scale in patients surviving OHR was analysed. We al so studied the effect of these predictive factors and the in-hospital treat ment (percutaneous transluminal coronary angioplasty (PTCA) vs. thrombolysi s) on mortality. We performed a retrospective analysis of the emergency med ical system forms and medical files of 72 consecutive patients aged greater than or equal to 18 years with sOHR. Of these 72 patients 37 (51%) met the electrocardiographic and enzymatic criteria for acute myocardial infarctio n (AMI). Ten of the 37 AMI patients (27%) underwent acute PTCA as primary t reatment and seven patients (19%) received thrombolytic therapy for AMI des pite prolonged (mean 24.13 min) cardiopulmonary resuscitation (CPR). The re maining 20 patients had no specific infarct treatment. Despite successful P TCA, in eight out of ten patients, their mortality in hospital was 60% (6/1 0). Mortality in the thrombolysis group was 57% (4/7). For the remaining 20 MI-patients the mortality was 65% (13/20). Univariate and multivariate ana lyses were performed to design a weighted prognostic scoring system. The Gl asgow coma scale (GCS) was the strongest independent predictor (r = 0.76, P less than or equal to 0.001) for in-hospital death. Conclusions: in-hospit al mortality after successful OHR seems to largely depend on neurological s tatus at admission and much less on the specific treatment of myocardial in farction. The prognostic scoring system accurately predicted the in-hospita l mortality and can be used for early treatment stratification; however, it should be proven in a prospective study. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.