Long-term outcome of patients after out-of-hospital cardiac arrest in relation to treatment: a single-centre study

Bergman, Remco; Hiemstra, Bart; Nieuwland, Wybe; Lipsic, Eric; Absalom, Anthony; Naalt, Joukje van der; Zijlstra, Felix; Horst, Iwan C. C. van der; Nijsten, Maarten W. N.

doi:10.1177/2048872615590144

Cited by 26 publications

(35 citation statements)

References 53 publications

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“…The PCI rate (100% – all 131 patients underwent CAG within 6 h) in our study is higher than in most recent studies (11% [8] – 73% [9]). CAD in post-cardiac arrest NSTEMI patients was found more frequently in the current study (88.2%) compared to most of the published data (21–58%) [6, 10, 11]. As many data [2, 4, 6, 8, 11–13] support invasive strategies for all, even NSTEMI OHCA survivors, we may presume that urgent CAG and PCI, when indicated, has a significant impact on superior survival to hospital discharge.…”

Section: Discussioncontrasting

confidence: 54%

“…Superior outcomes after OHCA in relation to the initial rhythm of ventricular fibrillation, which was dominant in our study (92.4%), have been observed in resent studies [11, 15]. Ventricular fibrillation as an initial rhythm may add benefits to the better than average rate of survival to hospital discharge (70.2%) in our study population, compared to other published data, where it varies between 31.8 and 37% [12, 15].…”

Section: Discussionsupporting

confidence: 54%

“…While many studies define TH to have a significant impact on short-term survival [12, 15], in consistence with Bergman et al [11] our study did not prove induced TH to be associated with better outcomes after OHCA. The survival to hospital discharge rate in TH and non-TH groups was 47% vs. 56% as reported by Bergman et al [11] compared to 8% and 92% in our study. Moreover, TH was associated with cold-caused complications in the current analysis.…”

Section: Discussionsupporting

confidence: 51%

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Outcomes of in-hospital treatment of cardiac patients who survived cardiac arrest and experienced coronary angiography

Barauskas

Unikas

Žiubrytė

2018

Arch Med Sci Atheroscler Dis

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IntroductionAs coronary artery disease is the most frequent cause of cardiac arrest, early invasive strategies may be beneficial for such patients. This study analyses the impact of in-hospital treatment on short-term outcomes of out-of-hospital cardiac arrest (OHCA) survivors.Material and methodsPatients admitted to the Cardiac Intensive Care Unit of our hospital within 2-year period were prospectively included in the study.ResultsOne hundred thirty-one patients were included in the study, which showed that in-hospital mortality increases uniformly with the severity of the coronary artery lesion (p = 0.044), but an effect of revascularization on number of deaths was not observed (p = 0.64). The presence of coma (p = 0.005) and the combination of male sex and age above 60-year as 2.2-fold (p = 0.048) increasing in-hospital mortality were found. The highest mortality rate occurred during the first 3 days and the death rate of the patients who survived this period is low. We found reduced left ventricular ejection fraction (OR = 6.54; 95% CI: 1.98–21.63; p = 0.002), non-ventricular fibrillation initial rhythm (OR = 2.94; 95% CI: 1.25–6.90; p = 0.014), unconscious at admission (OR = 6.46; 95% CI: 1.96–21.24; p = 0.002) and post-resuscitation coma (OR = 6.00; 95% CI: 2.63–13.66; p < 0.001) or encephalopathy (OR = 2.71; 95% CI: 1.9–6.72; p = 0.031) to be significant prognostic factors for higher in-hospital mortality rate.ConclusionsWe recommend immediate coronary interventions for all survivors of OHCA regardless of their state of consciousness and absence of ischaemic changes on ECG. Early intensive treatment for OHCA patients is indispensable, as the highest mortality rate is within the first 3 days after an event.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionsupporting

confidence: 54%

Section: Discussionsupporting

confidence: 51%

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Outcomes of in-hospital treatment of cardiac patients who survived cardiac arrest and experienced coronary angiography

Barauskas

Unikas

Žiubrytė

2018

Arch Med Sci Atheroscler Dis

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“…[1] Among SCA patients who survive to hospital discharge, numerous factors are associated with long-term outcomes including baseline characteristics such as age, race, initial arrest rhythm, etiology and duration,[2–4] intermediate outcomes such as neurological status at hospital discharge,[5] and specific treatments such as use of targeted temperature management (TTM), coronary angiography and internal defibrillator implantation. [2, 6–8] Although individual interventions are associated with improved survival, the overall effect of treatment at a high-volume center with organized systems of care for SCA is less clear.…”

Section: Introductionmentioning

confidence: 99%

Long-term survival benefit from treatment at a specialty center after cardiac arrest

et al. 2016

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Introduction The Institute of Medicine and American Heart Association have called for tiered accreditation standards and regionalization of post-cardiac arrest care, but there is little data to support that regionalization has a durable effect on patient outcomes. We tested the effect of treatment at a high-volume center on long-term outcome after sudden cardiac arrest (SCA). Methods We included patients hospitalized at one of 7 medical centers in Southwestern Pennsylvania after SCA from 2005 to 2013. Centers were one regional referral center with an organized systems for post-SCA care, two moderate volume tertiary care centers and 4 low-volume centers. We abstracted clinical characteristics and outcomes at hospital discharge, and for survivors to discharge we queried the National Death Index for long-term survival data. We used Cox regression to determine the unadjusted associations of baseline predictors and survival, and built an adjusted model controlling for baseline predictors. Results Overall, 987 patients survived to discharge. During 2196 person-years of follow-up, median survival was 5.3 years and there were 396 deaths. In unadjusted analysis, treating center, age, arrest location, Charlson Comorbidity Index, initial rhythm, cardiac catheterization, defibrillator placement, discharge disposition, and neurological status at discharge were associated with long-term outcome. In adjusted analysis, treatment at the high-volume cardiac arrest center was associated with improved survival compared to treatment at other centers (hazards ratio 1.49, 95% confidence interval 1.19 – 1.86). Conclusion Treatment at a high-volume cardiac arrest center with organized systems for post-arrest care is associated with a substantial long-term survival benefit after hospital discharge.

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“…Some studies were excluded due to our inability to differentiate between STEMI and NSTEMI subgroups from the heterogeneous population of OHCA patients. [ 18 – 22 ] The detailed literature search can be seen in Figure 1 . Baseline demographic and clinical characteristics of all the studies are outlined in Supplemental Table 1.…”

Section: Resultsmentioning

confidence: 99%

Coronary angiography or not after cardiac arrest without ST segment elevation

Yang

et al. 2020

Medicine

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Objective: This meta-analysis aimed to review the available evidence and evaluate the necessity of immediate coronary angiography (CAG) to obtain positive outcomes for out-of-hospital cardiac arrest (OHCA) patients without ST segment elevation. Data sources: Web of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases. Study selection: We included observational and case–control studies of outcomes among individuals without ST segment elevation experiencing OHCA who had immediate, delayed, or no CAG. Data extraction: We extracted study details, as well as patient characteristics and outcomes. Data synthesis: Six studies (n = 2665) investigating mortality until discharge demonstrated a significant increase in survival benefit with early CAG (odds ratio [OR] = 1.78; 95%CI = 1.51–2.11; I 2 = 81%; P < .0001). Seven studies (n = 2909) showed a significant preservation of neurological functions with early CAG at discharge (OR = 1.66; 95%CI = 1.37–2.02; P < .00001). Four studies (n = 1357) investigating survival outcomes with middle-term follow-up revealed no significant benefit with early CAG (OR = 1.21; 95%CI = 0.93–1.57; I 2 = 66%; P = .15). Conclusions: Our meta-analysis demonstrates that there may be significant benefits in performing immediate CAG on patients who experience OHCA without ST segment elevation.

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Long-term outcome of patients after out-of-hospital cardiac arrest in relation to treatment: a single-centre study

Cited by 26 publications

References 53 publications

Outcomes of in-hospital treatment of cardiac patients who survived cardiac arrest and experienced coronary angiography

Outcomes of in-hospital treatment of cardiac patients who survived cardiac arrest and experienced coronary angiography

Long-term survival benefit from treatment at a specialty center after cardiac arrest

Coronary angiography or not after cardiac arrest without ST segment elevation

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