Predictors for Outcome Among Cardiac Arrest Patients: the Importance of Initial Cardiac Arrest Rhythm Versus Time to Return of Spontaneous Circulation, a Retrospective Cohort Study

Overview

Journal BMC Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2015 Feb 5

PMID 25648841

Citations 30

Authors

Ida Wibrandt

Kristine Norsted

Henrik Schmidt

Jens Schierbeck

Affiliations

Soon will be listed here.

Abstract

Background: In the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors for outcome among CA patients, we can improve the management of CA, in order to strengthen the leads in the chain of survival.

Methods: A retrospective cohort study including 172 CA patients admitted to the intensive care unit (ICU) in Odense University Hospital (OUH) in a three-year period was conducted. We determined the 90-day mortality and neurological outcome at discharge for CA patients treated with therapeutic hypothermia (TH), in regard to determine the importance of the predictors for mortality and neurological outcome, with emphasize on combining initial rhythm and time to return of spontaneous circulation (ROSC).

Results: The overall mortality was 44% and a favorable neurological outcome was seen among 52%. Strong predictors for survival and favorable neurological outcome were ventricular tachycardia/ventricular fibrillation (VT/VF) as initial rhythm, cardiac etiology and time to ROSC < 20 minutes. Age < 60 years was a predictor for survival only. Patients with the combination of VT/VF and ROSC < 20 minutes had undeniably the best chance of both survival and a favorable neurological outcome.

Conclusions: We found significant predictors for both survival and neurological outcome, in which an initial rhythm of VT/VF and a cardiac etiology were the strongest.

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A Comparison of Prognostic Factors in a Large Cohort of In-Hospital and Out-of-Hospital Cardiac Arrest Patients.

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Predictors of neurological outcome after out-of-hospital cardiac arrest: sex-based analysis: do males derive greater benefit from hypothermia management than females?.

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References

Herlitz J, Engdahl J, Svensson L, Angquist K, Young M, Holmberg S . Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden. Am Heart J. 2005; 149(1):61-6. DOI: 10.1016/j.ahj.2004.07.014. View

Jacobs I, Nadkarni V, Bahr J, Berg R, Billi J, Bossaert L . Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the international liaison committee on.... Resuscitation. 2004; 63(3):233-49. DOI: 10.1016/j.resuscitation.2004.09.008. View

Nolan J, Morley P, Vanden Hoek T, Hickey R . Therapeutic hypothermia after cardiac arrest. An advisory statement by the Advancement Life support Task Force of the International Liaison committee on Resuscitation. Resuscitation. 2003; 57(3):231-5. DOI: 10.1016/s0300-9572(03)00184-9. View

Bernard S, Gray T, Buist M, Jones B, Silvester W, Gutteridge G . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346(8):557-63. DOI: 10.1056/NEJMoa003289. View

. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346(8):549-56. DOI: 10.1056/NEJMoa012689. View

Holmberg M, Holmberg S, Herlitz J . Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in sweden. Resuscitation. 2000; 44(1):7-17. DOI: 10.1016/s0300-9572(99)00155-0. View

Nolan J, Deakin C, Soar J, Bottiger B, Smith G . European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation. 2005; 67 Suppl 1:S39-86. DOI: 10.1016/j.resuscitation.2005.10.009. View

Belliard G, Catez E, Charron C, Caille V, Aegerter P, Dubourg O . Efficacy of therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation. Resuscitation. 2007; 75(2):252-9. DOI: 10.1016/j.resuscitation.2007.04.014. View

Hay A, Swann D, Bell K, Walsh T, Cook B . Therapeutic hypothermia in comatose patients after out-of-hospital cardiac arrest. Anaesthesia. 2007; 63(1):15-9. DOI: 10.1111/j.1365-2044.2007.05262.x. View

10.

Oddo M, Ribordy V, Feihl F, Rossetti A, Schaller M, Chiolero R . Early predictors of outcome in comatose survivors of ventricular fibrillation and non-ventricular fibrillation cardiac arrest treated with hypothermia: a prospective study. Crit Care Med. 2008; 36(8):2296-301. DOI: 10.1097/CCM.0b013e3181802599. View

11.

Nolan J, Neumar R, Adrie C, Aibiki M, Berg R, Bottiger B . Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee;.... Resuscitation. 2008; 79(3):350-79. DOI: 10.1016/j.resuscitation.2008.09.017. View

12.

Larsen L, Kristensen K, Kirkegaard H . [Therapeutic hypothermia after cardiac arrest]. Ugeskr Laeger. 2009; 171(17):1392-6. View

13.

Nunnally M, Jaeschke R, Bellingan G, Lacroix J, Mourvillier B, Rodriguez-Vega G . Targeted temperature management in critical care: a report and recommendations from five professional societies. Crit Care Med. 2010; 39(5):1113-25. DOI: 10.1097/CCM.0b013e318206bab2. View

14.

Storm C, Nee J, Roser M, Jorres A, Hasper D . Mild hypothermia treatment in patients resuscitated from non-shockable cardiac arrest. Emerg Med J. 2011; 29(2):100-3. DOI: 10.1136/emj.2010.105171. View

15.

Wissenberg M, Lippert F, Folke F, Weeke P, Hansen C, Christensen E . Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest. JAMA. 2013; 310(13):1377-84. DOI: 10.1001/jama.2013.278483. View

16.

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C . Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23):2197-206. DOI: 10.1056/NEJMoa1310519. View

17.

Lindner T, Langorgen J, Sunde K, Larsen A, Kvaloy J, Heltne J . Factors predicting the use of therapeutic hypothermia and survival in unconscious out-of-hospital cardiac arrest patients admitted to the ICU. Crit Care. 2013; 17(4):R147. PMC: 4057368. DOI: 10.1186/cc12826. View

18.

Harrison D, Patel K, Nixon E, Soar J, Smith G, Gwinnutt C . Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team. Resuscitation. 2014; 85(8):993-1000. PMC: 4111919. DOI: 10.1016/j.resuscitation.2014.05.004. View

19.

Agarwal D, Hess E, Atkinson E, White R . Ventricular fibrillation in Rochester, Minnesota: experience over 18 years. Resuscitation. 2009; 80(11):1253-8. DOI: 10.1016/j.resuscitation.2009.07.019. View

20.

Nielsen N, Hovdenes J, Nilsson F, Rubertsson S, Stammet P, Sunde K . Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest. Acta Anaesthesiol Scand. 2009; 53(7):926-34. DOI: 10.1111/j.1399-6576.2009.02021.x. View