Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management

Engsig, Magaly; Søholm, Helle; Folke, Fredrik; Gadegaard, Peter J; Wiis, J.; Molin, Rune; Mohr, Thomas; Engsig, Frederik Neess

doi:10.2147/clep.s114946

Cited by 17 publications

(31 citation statements)

References 26 publications

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“…A possible explanation of this finding could be that OHCA patients primarily die from severe neurological injury leading to WLST, and thereby have affected NPi values, whereas IHCA patients and patients with other diagnoses than cardiac arrest also die from non-neurological complications, for example cardiogenic shock and sepsis not likely to affect the pupillary light reflex. 30,33,34 In accordance with previous studies made in OHCA patients we found that automated pupillometry has a high predictive value, complementing clinical tools such as EEG, SSEPs and neuron-specific enolase. 35,36 One major advantage of pupillometry is the simplicity of the procedure.…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

Obling

Hassager

Illum

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background: Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint. Methods: A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities. Results: In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values. Conclusion: Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

Obling

Hassager

Illum

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…This 1-year mortality rate was slightly higher in IHCA patients than in OHCA patients. Though in a smaller sample, Engsig et al 25 investigated long-term outcomes and showed comparable 1-year mortality rates, which were similar for IHCA and OHCA patients (47% and 51%, respectively). We found a stable 1-year mortality rate between 2010 and 2016 for IHCA patients.…”

Section: Discussionmentioning

confidence: 98%

“…As stated in the 2015 guidelines, since 2010, a temperature of 32À34 C is recommended, which changed in 2015 to 36 C. 22 Several studies showed different results in goal temperatures for the TTM, but they all recommend using hypothermia or normothermia and preventing hyperthermia. 8,22,35À37 However, Engsig et al 25 showed no difference in IHCA and OHCA patients. Wang et al 38 showed a benefit for TTM in IHCA patients, but TTM was performed in only 3.2% of the patients.…”

Section: Discussionmentioning

confidence: 99%

A nationwide overview of 1-year mortality in cardiac arrest patients admitted to intensive care units in the Netherlands between 2010 and 2016

et al. 2020

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Aim: Worldwide, cardiac arrest (CA) remains a major cause of death. Most post-CA patients are admitted to the intensive care unit (ICU). The aim of this study is to describe mortality rates and possible changes in mortality rates in patients with CA admitted to the ICU in the Netherlands between 2010 and 2016.Methods: In this study, we included all adult CA patients registered in the National Intensive Care Evaluation (NICE) registry who were admitted to ICUs in the Netherlands between 2010 and 2016. The primary outcome was 1-year mortality which was analysed by Cox regression. The secondary outcomes were ICU mortality and hospital mortality. Hospital mortality was analysed by binary logistic regression analysis. Patients were stratified by whether they experienced in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA). Finally, the outcome over calendar time was assessed for both groups.Results: We included 26,056 CA patients: 10,618 (40.8%) IHCA patients and 14,482 (55.6%) OHCA patients. The 1-year mortality rate was 57.5%: 59% for IHCA and 56.4% for OHCA, p < 0.01. This mortality rate remained stable between 2010 and 2016 for IHCA (p = 0.31) and declined for OHCA patients (p = 0.01). The hospital mortality rate was 50.3%: 50.5% for IHCA and 50.2% for OHCA, p = 0.66. This mortality rate remained stable between 2010À2016 for IHCA (p = 0.21) and decreased for OHCA patients (p < 0.01). An additional analysis with calendar year as a continuous variable showed a mortality decline of 1.56% per calendar year for 1-year mortality. Conclusion:This nationwide registry cohort study reported a 57.5% 1-year mortality rate for CA patients admitted to the ICU between 2010 and 2016.We reported a decline in 1-year mortality for OHCA patients in these years.

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“…The results of this study were not considered powerful enough to change the recommendation in guidelines [ 29 ]. On the other hand, when comparing IHCA and OHCA patients treated with TTM, 2 retrospective studies published in 2016 showed no differences in short- and long-term survival rates or neurologic outcomes, indicating the benefits of TTM for both groups might be similar [ 6 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Targeted Temperature Management for In-Hospital and Out-Of-Hospital Cardiac Arrest: A Matched Case-Control Study Using the National Database of Taiwan Network of Targeted Temperature Management for Cardiac Arrest (TIMECARD) Registry

et al. 2021

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Background This study aimed to compare outcomes of targeted temperature management (TTM) for patients with in-hospital and out-of-hospital cardiac arrest using the national database of TaIwan network of targeted temperature ManagEment for CARDiac arrest (TIMECARD) registry. Material/Methods A retrospective, matched, case-control study was conducted. Patients with in-hospital cardiac arrest (IHCA) treated with TTM after the return of spontaneous circulation (ROSC) were selected as the case group and controls were defined as the same number of patients with out-of-hospital cardiac arrest (OHCA), matched for sex, age, Charlson comorbidity index, and cerebral performance category. Neurological outcome and survival at hospital discharge were the primary outcome measures. Results Data of 103 patients with IHCA and matched controls with OHCA were analyzed. Patients with IHCA were more likely to experience witnessed arrest and bystander cardiopulmonary resuscitation (CPR). The duration from collapse to the beginning of CPR, CPR time, and the duration from ROSC to initiation of TTM were shorter in the IHCA group but their initial arterial blood pressure after ROSC was lower. Overall, 88% of patients survived to completion of TTM and 43% survived to hospital discharge. Hospital survival (42.7% vs 42.7%, P =1.00) and favorable neurological outcome at discharge (19.4% vs 12.7%, P =0.25) did not differ between the 2 groups. Conclusions The findings from the national TIMECARD registry showed that clinical outcomes following TTM for patients with IHCA were not significantly different from OHCA when baseline factors were matched.

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Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management

Cited by 17 publications

References 26 publications

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

A nationwide overview of 1-year mortality in cardiac arrest patients admitted to intensive care units in the Netherlands between 2010 and 2016

Outcomes of Targeted Temperature Management for In-Hospital and Out-Of-Hospital Cardiac Arrest: A Matched Case-Control Study Using the National Database of Taiwan Network of Targeted Temperature Management for Cardiac Arrest (TIMECARD) Registry

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