Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients

Abstract

Re-arrest during post-cardiac arrest care after the return of spontaneous circulation is not uncommon. However, little is known about the risk factors associated with re-arrest. A previous study failed to show a benefit of prophylactic antiarrhythmic drug infusion in all kinds of out-of-hospital cardiac arrest (OHCA) survivors. This study evaluated high-risk OHCA survivors who may have re-arrest with shockable rhythm during targeted temperature management (TTM). Medical records of consecutive OHCA survivors treated with TTM at four tertiary referral university hospitals in the Republic of Korea between January 2010 and December 2016 were retrospectively reviewed. Patients who did not have any shockable rhythm during cardiopulmonary resuscitation (CPR) or unknown initial rhythm were excluded. The primary outcome of interest was the recurrence of shockable cardiac arrest during TTM. There were 289 cases of initial shockable arrest rhythm and 132 cases of shockable rhythm during CPR. Of the 421 included patients, 11.4% of patients had a shockable re-arrest during TTM. Survival to discharge and good neurologic outcomes did not differ between non-shockable and shockable re-arrest patients (78.3% vs. 72.9%, p = 0.401; 53.1% vs. 54.2% p = 0.887). Initial serum magnesium level, ST segment depression or ventricular premature complex (VPC) in initial electrocardiography (ECG), prophylactic amiodarone infusion, and dopamine and norepinephrine infusion during TTM were significantly higher and more frequent in the shockable re-arrest group (all p values < 0.05). Normal ST and T wave in initial ECG was common in the non-shockable re-arrest group (p = 0.038). However, in multivariate logistic regression analysis, only VPC was an independent prognostic factor for shockable re-arrest (OR 2.806 (95% CI 1.276–6.171), p = 0.010). Initial VPC may be a prognostic risk factor for shockable re-arrest in OHCA survivors with shockable rhythm.

Bedside monitoring of hypoxic ischemic brain injury using low-field, portable brain magnetic resonance imaging after cardiac arrest

“…27 Major critical events are related to haemodynamic instability, hypoxia, and other airway complications, all of which can contribute to secondary brain injury or pose life-threatening consequences given the high-risk for recurrent arrest in this population. 27,28 Conventional MRI is performed in 22-40% of the comatose post-CA population and timing is often delayed by many patient-and systems-related factors. 29,30 Advances in low-magnetic field MRI have allowed for a paradigm shift, obtaining clinically useful neuroimaging at the bedside.…”

Association between the number of prehospital defibrillation attempts and a sustained return of spontaneous circulation: a retrospective, multicentre, registry-based study

“…With advances in cardiac arrest resuscitation, the rate of survival to hospital discharge in patients with out-of-hospital cardiac arrest (OHCA) ranges from 7.5% to 10.8% 1–3. The first monitored rhythm is ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) in approximately 20% of cardiac arrests, but the incidence of VF/pVT can vary according to bystander cardiopulmonary resuscitation (CPR) rates 4–7. These shockable rhythms occur at some stage during resuscitation in about 25% of cardiac arrests with an initial documented rhythm of asystole or pulseless electrical activity 8…”

Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

“…Clinically, post CA syndrome (PCAS), also known as sepsis-like syndrome, mimics the immunologic and coagulation disorders in patients with severe sepsis [8]. Despite advances in post-resuscitative care, a signi cant proportion of patients will have a poor neurological outcome and a high risk of mortality [3,9].…”