RT Journal Article
SR Electronic
T1 Use of implantable cardioverter defibrillators after out-of-hospital cardiac arrest: a prospective follow-up study
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 1053
OP 1056
DO 10.1503/cmaj.1031627
VO 171
IS 9
A1 Ratika Parkash
A1 Anthony Tang
A1 George Wells
A1 Josée Blackburn
A1 Ian Stiell
A1 Christopher Simpson
A1 Paul Dorian
A1 Raymond Yee
A1 Doug Cameron
A1 Stuart Connolly
A1 David Birnie
A1 Graham Nichol
YR 2004
UL http://www.cmaj.ca/content/171/9/1053.abstract
AB 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.