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

T Cassina; S Clivio; A Putzu; M Villa; T Moccetti; D Fortuna; G Casso

doi:10.1016/j.medin.2019.05.006

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

Med Intensiva (Engl Ed). 2020 Oct;44(7):409-419. doi: 10.1016/j.medin.2019.05.006. Epub 2019 Jul 24.

[Article in English, Spanish]

Authors

T Cassina¹, S Clivio², A Putzu², M Villa², T Moccetti³, D Fortuna⁴, G Casso²

Affiliations

¹ Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: tiziano.cassina@cardiocentro.org.
² Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland.
³ Department of Cardiology, Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland.
⁴ Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.

PMID: 31351737
DOI: 10.1016/j.medin.2019.05.006

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.

Keywords: Cardiac arrest; Desenlace neurológico; Mortalidad; Mortality; Neurological outcome; Out-of-hospital cardiac arrest; Parada cardíaca; Parada cardíaca extrahospitalaria; Regreso a la circulación espontánea; Return of spontaneous circulation.