CMAJ • October 26, 2004; 171 (9). doi:10.1503/cmaj.1031627.
© 2004 Canadian Medical Association or its licensors
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Use of implantable cardioverter defibrillators after out-of-hospital cardiac arrest: a prospective follow-up study

Ratika Parkash, Anthony Tang, George Wells, Josée Blackburn, Ian Stiell, Christopher Simpson, Paul Dorian, Raymond Yee, Doug Cameron, Stuart Connolly, David Birnie and Graham Nichol

From the Ottawa Heart Institute (Parkash, Tang, Birnie), the Ottawa Health Research Institute (Wells, Blackburn, Nichol), and the Department of Emergency Medicine, University of Ottawa (Stiell), Ottawa, Ont.; the Kingston General Hospital, Kingston, Ont. (Simpson); St. Michael's Hospital (Dorian) and the Toronto General Hospital (Cameron), Toronto, Ont.; the London Health Sciences Centre (Yee), London, Ont.; and the Hamilton Health Sciences Centre (Connolly), Hamilton, Ont.

Background: Survivors of out-of-hospital cardiac arrest are at high risk of recurrent arrests, many of which could be prevented with implantable cardioverter defibrillators (ICDs). We sought to determine the ICD insertion rate among survivors of out-of-hospital cardiac arrest and to determine factors associated with ICD implantation.

Methods: The Ontario Prehospital Advanced Life Support (OPALS) study is a prospective, multiphase, before–after study assessing the effectiveness of prehospital interventions for people experiencing cardiac arrest, trauma or respiratory arrest in 19 Ontario communities. We linked OPALS data describing survivors of cardiac arrest with data from all defibrillator implantation centres in Ontario.

Results: From January 1997 to April 2002, 454 patients in the OPALS study survived to hospital discharge after experiencing an out-of-hospital cardiac arrest. The mean age was 65 (standard deviation 14) years, 122 (26.9%) were women, 398 (87.7%) had a witnessed arrest, 372 (81.9%) had an initial rhythm of ventricular tachycardia or ventricular fibrillation (VT/VF), and 76 (16.7%) had asystole or another arrhythmia. The median cerebral performance category at discharge (range 1–5, 1 = normal) was 1. Only 58 (12.8%) of the 454 patients received an ICD. Patients with an initial rhythm of VT/VF were more likely than those with an initial rhythm of asystole or another rhythm to undergo device insertion (adjusted odds ratio [OR] 9.63, 95% confidence interval [CI] 1.31–71.50). Similarly, patients with a normal cerebral performance score were more likely than those with abnormal scores to undergo ICD insertion (adjusted OR 12.52, 95% CI 1.74–92.12).

Interpretation: A minority of patients who survived cardiac arrest underwent ICD insertion. It is unclear whether this low usage rate reflects referral bias, selection bias by electrophysiologists, supply constraint or patient preference.


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Implantable cardioverter defibrillators: therapy against Canada's leading killer
Darryl R. Davis and Anthony S.L. Tang
Can. Med. Assoc. J. 2004 171: 1037-1038. [Full Text] [PDF]



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D. H. Birnie MB ChB MD, C. Sambell BSc, H. Johansen PhD, K. Williams MS, R. Lemery MD, M. S. Green MD, M. H. Gollob MD, D. S. Lee MD PhD, and A. S.L. Tang MD
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