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

Details

Serval ID
serval:BIB_EE11E67F2F22
Type
Article: article from journal or magazin.
Collection
Publications
Title
Neurological outcome and modifiable events after out-of-hospital cardiac arrest in patients managed in a tertiary cardiac centre: A ten years register.
Journal
Medicina intensiva
Author(s)
Cassina T., Clivio S., Putzu A., Villa M., Moccetti T., Fortuna D., Casso G.
ISSN
1578-6749 (Electronic)
ISSN-L
0210-5691
Publication state
Published
Issued date
24/07/2019
Peer-reviewed
Oui
Language
english spanish
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
A study was made of the events occurring in the early post-resuscitation phase that may help to improve the outcomes at hospital discharge.
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.
A tertiary cardiac centre.
Unconscious victims of out-of-hospital cardiac arrest (OHCA) with documented ventricular tachycardia or fibrillation.
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).
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.
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
Pubmed
Create date
03/12/2019 14:55
Last modification date
02/05/2020 20:09
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