Overall survival and brain death frequency following out-of-hospital cardiac arrest

Abstract

Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality that is responsible for over 300,000 deaths in the United States each year. Underlying cardiac etiologies remain the most common culprit. Despite medical advances in the treatment of coronary artery disease, the mortality following OHCA remains dismal. Additionally, of those who survive the initial event, many are left with debilitating and irreversible anoxic brain injuries. Therefore, improving survival as well as neurologic outcome is of primary importance in this group. Our goal was to evaluate the underlying etiologies, neurologic outcomes, and cardiac interventions being performed in patients with OHCA presenting to our large tertiary care center. We retrospectively reviewed 181 charts of patients presenting to our emergency department over a 1-year time period with a diagnosis of OHCA. Following exclusion criteria, 130 patients remained, with 17 of those surviving to hospital admission. Of the 17 initial survivors, only 9 survived to hospital discharge and only 6 of those obtained good neurologic outcomes. Additionally, there was no mortality benefit in the 4 patients who had coronary angiography or percutaneous intervention.

Early coronary angioplasty fails to lower all‐cause mortality in patients with out‐of‐hospital cardiac arrest without ST‐segment elevation: A systematic review and meta‐analysis

“…This study was designed and conducted around the following research question: "Does performing early CAG improve mortality and/or neurological outcomes in patients with OHCA and no STsegment elevations on postarrest electrocardiogram (ECG)?" Therefore, we included randomized control trials (RCTs), observational studies, and cohort studies that reported adults (over 18 years of age) who suffered from cardiac arrest outside of the hospital, diagnosed to have non-ST segment elevation myocardial infarction (NSTEMI), and with reported mortality and/or neurological outcomes, namely the cerebral performance category scores (CPC), which is a 5-point standard scale that ranges from good cerebral performance (1) to brain death (5). Letters to the editors, conference abstracts, case reports and case series, pediatric studies, commentaries, and duplicates were excluded from the finalized pool of studies.…”

“… 3 Despite improvements made within the last two decades, mortality and morbidity remain high, with only 1 in 10 surviving to hospital discharge. 4 With such high mortality rates and poor neurological outcomes, 5 OHCA remains a major public health burden that requires immediate identification and appropriate management.…”