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Neurological outcome and modifiable events after out-of-hospital cardiac arrest in patients managed in a tertiary cardiac centre: A ten years register


Cassina, T; Clivio, S; Putzu, A; Villa, M; Moccetti, T; Fortuna, D; Casso, G (2020). Neurological outcome and modifiable events after out-of-hospital cardiac arrest in patients managed in a tertiary cardiac centre: A ten years register. Medicina Intensiva, 44(7):409-419.

Abstract

OBJECTIVE
A study was made of the events occurring in the early post-resuscitation phase that may help to improve the outcomes at hospital discharge.
DESIGN
A retrospective cohort study (2007-2017) of a prospective Utstein type registry database was carried using multivariate logistic regression analysis. Pre- and post-hospital admission events were investigated.
SETTING
A tertiary cardiac centre.
PARTICIPANTS
Unconscious victims of out-of-hospital cardiac arrest (OHCA) with documented ventricular tachycardia or fibrillation.
MAIN VARIABLES OF INTEREST
Events occurring before and within 72h after intensive care unit (ICU) admission were recorded. The variables were analyzed to determine their impact on hospital survival and poor neurological outcome. One-year follow-up survival was also considered. Results are presented as odds ratio (OR) and 95% confidence interval (95%CI).
RESULTS
Of 245 patients admitted to our ICU after OHCA, 152 (62%) were alive and 131 (86.2%) presented good neurological outcomes (cerebral performance categories≤2) at hospital discharge. The one-year follow-up survival rate was 95.9%. Age >70 years (OR 2.0; 95%CI 1.1-4.1), previous myocardial infarction (OR 2.7; 95%CI 1.2-6.1), shock upon hospital admission (OR 2.9; 95%CI 1.3-6.2), time from call to return of spontaneous circulation (ROSC) >25min (OR 3.1; 95%CI 1.6-6.0) and anticonvulsant therapy (OR 18.2; 95%CI 5.5-60) were independent predictors of poor neurological outcome. Immediate admission to the cardiac centre (OR 0.5; 95%CI 0.3-0.9) and lactate clearance reaching plasma levels <2.5mmol/l at 12h (OR 0.4; 95%CI 0.2-0.8) were associated with better outcomes.
CONCLUSIONS
Unconscious OHCA patients with documented ventricular tachycardia or fibrillation may benefit from direct admission to a reference cardiac centre. Initial haemodynamic support, urgent coronary angiography and targeted management in the cardiac ICU seem to increase the likelihood of good neurological outcomes.

Abstract

OBJECTIVE
A study was made of the events occurring in the early post-resuscitation phase that may help to improve the outcomes at hospital discharge.
DESIGN
A retrospective cohort study (2007-2017) of a prospective Utstein type registry database was carried using multivariate logistic regression analysis. Pre- and post-hospital admission events were investigated.
SETTING
A tertiary cardiac centre.
PARTICIPANTS
Unconscious victims of out-of-hospital cardiac arrest (OHCA) with documented ventricular tachycardia or fibrillation.
MAIN VARIABLES OF INTEREST
Events occurring before and within 72h after intensive care unit (ICU) admission were recorded. The variables were analyzed to determine their impact on hospital survival and poor neurological outcome. One-year follow-up survival was also considered. Results are presented as odds ratio (OR) and 95% confidence interval (95%CI).
RESULTS
Of 245 patients admitted to our ICU after OHCA, 152 (62%) were alive and 131 (86.2%) presented good neurological outcomes (cerebral performance categories≤2) at hospital discharge. The one-year follow-up survival rate was 95.9%. Age >70 years (OR 2.0; 95%CI 1.1-4.1), previous myocardial infarction (OR 2.7; 95%CI 1.2-6.1), shock upon hospital admission (OR 2.9; 95%CI 1.3-6.2), time from call to return of spontaneous circulation (ROSC) >25min (OR 3.1; 95%CI 1.6-6.0) and anticonvulsant therapy (OR 18.2; 95%CI 5.5-60) were independent predictors of poor neurological outcome. Immediate admission to the cardiac centre (OR 0.5; 95%CI 0.3-0.9) and lactate clearance reaching plasma levels <2.5mmol/l at 12h (OR 0.4; 95%CI 0.2-0.8) were associated with better outcomes.
CONCLUSIONS
Unconscious OHCA patients with documented ventricular tachycardia or fibrillation may benefit from direct admission to a reference cardiac centre. Initial haemodynamic support, urgent coronary angiography and targeted management in the cardiac ICU seem to increase the likelihood of good neurological outcomes.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Critical Care and Intensive Care Medicine
Language:English
Date:1 October 2020
Deposited On:29 Jan 2020 13:32
Last Modified:09 Oct 2020 01:03
Publisher:Ediciones Doyma, S.L.
ISSN:0210-5691
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.medin.2019.05.006
PubMed ID:31351737

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