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The Postcardiac Arrest Consult Team: Impact on Hospital Care Processes for Out-of-Hospital Cardiac Arrest Patients*

Brooks, Steven C. MD, MHSc, FRCPC; Scales, Damon C. MD, PhD, FRCPC; Pinto, Ruxandra PhD; Dainty, Katie N. PhD; Racz, Elizabeth M. BA, BHSC, MSc(c); Gaudio, Michelle BSc; Amaral, Andre C. K. B. MD; Gray, Sara H. MD, MPH, FRCPC; Friedrich, Jan O. MD, DPhil, FRCPC; Chapman, Martin BM, FRCA, FRCPC; Dorian, Paul MD, MSc, FRCPC; Fam, Neil MD, MSc, FRCPC; Fowler, Robert A. MDCM, MS (Epi), FRCPC; Hayes, Chris W. MD, MSc, MEd, FRCPC; Baker, Andrew MD, FRCPC; Crystal, Eugene MD; Madan, Mina MD, MHS, FRCPC, FSCAI; Rubenfeld, Gordon MD, MSc; Smith, Orla M. RN, PhD; Morrison, Laurie J. MD, MHSc, FRCPC

doi: 10.1097/CCM.0000000000001863
Clinical Investigations

Objective: To evaluate whether a Post-Arrest Consult Team improved care and outcomes for patients with out-of-hospital cardiac arrest.

Design: Prospective cohort study of Post-Arrest Consult Team implementation at two hospitals, with concurrent controls from 27 others.

Setting: Twenty-nine hospitals within the Strategies for Post-Arrest Care Network of Southern Ontario, Canada.

Patients: We included comatose adult nontraumatic out-of-hospital cardiac arrest patients surviving more than or equal to 6 hours after emergency department arrival who had no contraindications to targeted temperature management.

Intervention: The Post-Arrest Consult Team was an advisory consult service to improve 1) targeted temperature management, 2) assessment for percutaneous coronary intervention, 3) electrophysiology assessment, and 4) appropriately delayed neuroprognostication.

Measurements and Main Results: We used generalized linear mixed models to explore the association between Post-Arrest Consult Team implementation and performance of targeted processes. We included 1,006 patients. The Post-Arrest Consult Team was associated with a significant reduction over time in rates of withdrawal of life-sustaining therapy within 72 hours of emergency department arrival on the basis of predictions of poor neurologic prognosis (ratio of odds ratios, 0.13; 95% CI, 0.02–0.98). Post-Arrest Consult Team was not associated with improved successful targeted temperature management (ratio of odds ratios, 0.91; 95% CI, 0.31–2.65), undergoing angiography (ratio of odds ratios, 1.91; 95% CI, 0.17–21.04), receiving electrophysiology consultation (ratio of odds ratios, 0.93; 95% CI, 0.11–8.16), or functional survival (ratio of odds ratios, 0.75; 95% CI, 0.19–2.94).

Conclusions: Implementation of a Post-Arrest Consult Team reduced premature withdrawal of life-sustaining therapy but did not improve rates of successful targeted temperature management, coronary angiography, formal electrophysiology assessments, or functional survival for comatose patients after out-of-hospital cardiac arrest.

1Department of Emergency Medicine, Queen’s University, Kingston, ON, Canada.

2Rescu, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada.

3Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

4Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.

6Critical Care Department, St. Michael’s Hospital, Toronto, ON, Canada.

7Department of Emergency Medicine, St. Michael’s Hospital, Toronto, ON, Canada.

8Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.

9Heart and Vascular Program, St. Michael’s Hospital, Toronto, ON, Canada.

10Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada.

11Department of Anesthesia, St. Michael’s Hospital, Toronto, ON, Canada.

12Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.

*See also p. 2113.

This study was conducted at Sunnybrook Health Sciences Centre and St. Michael’s in Toronto, ON, Canada, as well as Queen’s University in Kingston, ON, Canada.

Supported, in part, by an operating grant from the Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research in the form of a partnership funding opportunity called the Resuscitation and Knowledge Transfer and Exchange 2010 Initiative. Also, grants from the Alternative Funding Plan Innovation Fund through the Ontario Ministry of Health and Long Term Care supported the work reported in this article. Preliminary support for this project was provided through a Connaught New Staff Matching Grant from the University of Toronto.

Dr. Brooks disclosed other support (coauthor support: Dr. Scales is supported by a Graham Farquharson Knowledge Translation Fellowship from the Physicians’ Services Incorporated Foundation. Dr. Fowler’s work was supported by a personnel award from the Heart and Stroke Foundation of Canada, Ontario Provincial Office. Dr. Morrison is supported by the Robert and Dorothy Pitts Chair in Emergency Medicine and Acute Care, Li Ka Shing Knowledge Institute, St Michael’s Hospital and receives salary support from the National Institutes of Health for her role as Principal Investigator for the Toronto Regional Coordinating Centre for the Resuscitation Outcomes Consortium. Dr. Brooks received funding from PulsePoint Foundation, the American Heart Association, and the Heart and Stroke Foundation of Canada. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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