Long-term survival among OHCA patients who survive to 30 days: Does initial arrest rhythm remain a prognostic determinant?

Majewski, David; Ball, Stephen; Bailey, Paul; Bray, Janet; Finn, Judith

doi:10.1016/j.resuscitation.2021.02.030

Cited by 23 publications

(30 citation statements)

References 22 publications

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“…However, in our paper we went further, analyzing not only the all EMS-treated OHCAs, but also all the different Utstein subgroups of OHCA patients. We indeed unexpectedly highlighted that the SMR is higher than the general population in those patients with more favorable OHCA characteristics, represented by the Utstein comparator group (shockable bystander witnessed) and the “shockable bystander CPR.” Our results are also in line with another recent Australian paper ( 35 ), which showed that patients with non-shockable arrests continued to experience disproportionately higher mortality than patients with an initial shockable arrest in long-term follow-up. Our results, taking into account other variables as suggested by Utstein categories and comparing the mortality risk to the general population, provide new useful information for the long-term management of surviving patients.…”

Section: Discussionsupporting

confidence: 93%

“…Our study, which includes all the OHCA cases that occurred in four provinces and were filed according to the Utstein style recommendations, should overcome selection bias. This is similar to four studies carried out in Israel ( 31 ), Canada ( 32 ), and Australia ( 33 – 35 ). Marcus et al ( 31 ) looked for differences in both survival and survival with good neurological outcome between patients aged over and under 80 years.…”

Section: Discussionsupporting

confidence: 88%

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Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Baldi

Compagnoni

Buratti

et al. 2021

Front. Cardiovasc. Med.

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Background: No data are available regarding long-term survival of out-of-hospital cardiac arrest (OHCA) patients based on different Utstein subgroups, which are expected to significantly differ in terms of survival. We aimed to provide the first long-term survival analysis of OHCA patients divided according to Utstein categories.Methods: We analyzed all the 4,924 OHCA cases prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 2015 to 2019. Pre-hospital data, survival, and cerebral performance category score (CPC) at 1, 6, and 12 months and then every year up to 5 years after the event were analyzed for each patient.Results: A decrease in survival was observed during the follow-up in all the Utstein categories. The risk of death of the “all-EMS treated” group exceeded the general population for all the years of follow-up with standardized mortality ratios (SMRs) of 23 (95%CI, 16.8–30.2), 6.8 (95%CI, 3.8–10.7), 3.8 (95%CI, 1.7–6.7), 4.05 (95%CI, 1.9–6.9), and 2.6 (95%CI, 1.03–4.8) from the first to the fifth year of follow-up. The risk of death was higher also for the Utstein categories “shockable bystander witnessed” and “shockable bystander CPR”: SMRs of 19.4 (95%CI, 11.3–29.8) and 19.4 (95%CI, 10.8–30.6) for the first year and of 6.8 (95%CI, 6.6–13) and 8.1 (95%CI, 3.1–15.3) for the second one, respectively. Similar results were observed considering the patients discharged with a CPC of 1–2.Conclusions: The mortality of OHCA patients discharged alive from the hospital is higher than the Italian standard population, also considering those with the most favorable OHCA characteristics and those discharged with good neurological outcome. Long-term follow-up should be included in the next Utstein-style revision.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 88%

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Baldi

Compagnoni

Buratti

et al. 2021

Front. Cardiovasc. Med.

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“…CI, confidence interval; OR, odds ratio fact that only patients with a shockable rhythm were eligible for the COACT trial which is associated with improved survival in OHCA. 11,12 The occurrence of bleeding and renal replacement therapy was not different between the treatment arms; hence no safety concerns were noted for the early invasive approach with regard to these endpoints. The need for renal replacement therapy due to acute renal failure was lower in the COACT study.…”

Section: Discussionmentioning

confidence: 97%

“…Of note, mortality differed noticeably between the large trials COACT and TOMAHAWK. This can probably be attributed to the fact that only patients with a shockable rhythm were eligible for the COACT trial which is associated with improved survival in OHCA 11,12 …”

Section: Discussionmentioning

confidence: 99%

Early coronary angiography in patients after out‐of‐hospital cardiac arrest without ST‐segment elevation: Meta‐analysis of randomized controlled trials

Freund

Royen

Kern

et al. 2022

Cathet Cardio Intervent

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Objectives: To compare early coronary angiography to a delayed or selective approach in out-of-hospital cardiac arrest (OHCA) without ST-segment elevation of possible cardiac cause by means of meta-analysis of available randomized controlled trials (RCTs). Methods: We searched MEDLINE and the Cochrane Central Register of ControlledTrials for RCTs comparing early with delayed or selective coronary angiography in OHCA patients of possible cardiac origin without ST-segment elevation. The primary endpoint was all-cause short-term mortality (PROSPERO CRD42021271484).Results: The search strategy identified three RCTs enrolling a total of 1167 patients. An early invasive approach was not associated with improved short-term mortality (odds ratio 1.19, 95% confidence interval 0.94-1.52; p = 0.15). Further, no significant differences were shown with respect to the risk of severe neurological deficit, the composite of all-cause mortality or severe neurological deficit, need for renal replacement therapy due to acute renal failure, and significant bleeding at short-term follow-up. Conclusion:Early coronary angiography in OHCA without ST-segment elevation is not superior compared to a delayed/selective approach.

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“…C. Shockable rhythm is a strong predictor associated with a presumed cardiac cause. Particularly, a good prognosis can be expected if the initial electrocardiogram is a shockable rhythm [18,19]. Even in an elderly patient group, shockable rhythm is a major prognostic factor [20].…”

Section: Discussionmentioning

confidence: 99%

KORHN risk score for early neuroprognostication in cardiac arrest patients

Choi,

Lee,

Jang

et al. 2022

Preprint

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Background:Early prediction of poor neurologic outcomes in patients who have recovered spontaneous circulation from out-of-hospital cardiac arrest (OHCA) is the important process that can help family relatives choose a course of treatment. This study aimed to create a scoring tool that could predict an early poor prognosis of comatose survivors from OHCA upon admission and to compare the prognostic value with existing models (MIRACLE, TTM, CAHP, C-GRApH, and OHCA scores).Methods:Using a cohort from the Korean Hypothermia Network (KORHN) registry in Korea, numerous variables including basic demographics, resuscitation, and post-resuscitation were extracted from 1,371 out of 10,258 OHCA patients. Variables for prognostication were analyzed, and the KORHN risk score was developed from the adjustment of scores through cubic spline plots. The performance of the score was compared with five staple risk scores.Results:Eight variables for predicting a poor neurologic outcome were identified: low flow time, heart rate/diastolic arterial pressure, noncardiac cause, unreactive pupil reflex, nonshockable rhythm, GCS motor, epinephrine use, and age (adjusted odds ratios 4.287, 3.523, 3.438, 3.393, 3.087, 2.614, 2.526, and 2.419, respectively). The KORHN score showed higher area under the curve values (0.925 and 0.914) than previous risk scores with whole variables (0.827–0.902) and the leading five variables (0.85–0.903).Conclusions:The KORHN score is a simple tool for the neuroprognostication of OHCA patients during admission. This study confirmed that the KORHN score is a good alternative to the existing scoring models in predicting poor neurological outcomes from OHCA patients.Trial registration:KORHN-PRO, NCT02827422. Registered 11 September 2016 – Retrospectively registered.

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Long-term survival among OHCA patients who survive to 30 days: Does initial arrest rhythm remain a prognostic determinant?

Cited by 23 publications

References 22 publications

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Early coronary angiography in patients after out‐of‐hospital cardiac arrest without ST‐segment elevation: Meta‐analysis of randomized controlled trials

KORHN risk score for early neuroprognostication in cardiac arrest patients

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