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Predictors of inhospital mortality following out-of-hospital cardiac arrest: insights from a single-centre consecutive case series

Predictors of inhospital mortality following out-of-hospital cardiac arrest: insights from a single-centre consecutive case series
Predictors of inhospital mortality following out-of-hospital cardiac arrest: insights from a single-centre consecutive case series

PURPOSE OF THE STUDY: Out-of-hospital cardiac arrest (OHCA) has a poor prognosis despite bystander resuscitation and rapid transfer to hospital. Optimal management of patients after arrival to hospital continues to be contentious, especially the timing of emergency coronary angiography±revascularisation. Robust predictors of inhospital outcome would be of clinical value for initial decision-making.

STUDY DESIGN: A retrospective analysis of consecutive patients who presented to a university hospital following OHCA over a 70-month period (2008-2013). Patients were identified from the emergency department electronic patient registration and coding system. For those patients who underwent emergency percutaneous coronary intervention, details were crosschecked with national databases.

RESULTS: We identified 350 consecutive patients who were brought to our hospital following OHCA. Return of spontaneous circulation (ROSC) for >20 min was achieved either before arrival or inhospital in 196 individuals. From the 350 subjects, 114 (32.6%) survived to hospital discharge. When sustained ROSC was achieved, either before or inhospital, survival to discharge was 58.2% (114 of 196). Non-shockable rhythm, absence of bystander cardiopulmonary resuscitation, 'downtime' >15 min and initial pH ≤7.11 were predictors of inhospital death. 12% patients who underwent angiography in the presence of ST elevation had no acute coronary occlusion. 21% patients with acute coronary occlusion at angiography did not have ST elevation.

CONCLUSIONS: In our cohort of patients with OHCA, those who achieve ROSC had a survival-to-discharge rate of 58.2%. We identified four predictors of inhospital death, which are readily available at the time of patient presentation. Reliance on ST elevation to decide about coronary angiography and revascularisation may be flawed. More data are required.

Aged, Cardiopulmonary Resuscitation/statistics & numerical data, Coronary Angiography/methods, Emergency Medical Services/methods, Female, Hospital Mortality, Humans, Hydrogen-Ion Concentration, Male, Myocardial Infarction/complications, Myocardial Revascularization/methods, Out-of-Hospital Cardiac Arrest/diagnosis, Outcome and Process Assessment (Health Care), Prognosis, Retrospective Studies, Survival Analysis, Time-to-Treatment, United Kingdom/epidemiology
0032-5473
250-254
Whittaker, Andrew
15b90577-3082-44e2-b238-d33da58bad1e
Lehal, Manpreet
f799e4f2-8c5b-47a4-a8d6-b7544afe92f6
Calver, Alison L
2ccb69df-80c1-4f98-92cd-6620b70387c0
Corbett, Simon
325a1edd-5325-4981-a5df-787d53f36d5e
Deakin, Charles D
560d993b-bbc9-4548-9990-272ed18a011d
Gray, Huon
5b0d4410-1689-40ec-b549-432c7c4d08dd
Simpson, Iain
a3d9424d-a76f-47c1-9886-7a277e8d7f5f
Wilkinson, James R
48866c95-4389-4ff1-ac68-c4eb6dfc5b87
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4
Whittaker, Andrew
15b90577-3082-44e2-b238-d33da58bad1e
Lehal, Manpreet
f799e4f2-8c5b-47a4-a8d6-b7544afe92f6
Calver, Alison L
2ccb69df-80c1-4f98-92cd-6620b70387c0
Corbett, Simon
325a1edd-5325-4981-a5df-787d53f36d5e
Deakin, Charles D
560d993b-bbc9-4548-9990-272ed18a011d
Gray, Huon
5b0d4410-1689-40ec-b549-432c7c4d08dd
Simpson, Iain
a3d9424d-a76f-47c1-9886-7a277e8d7f5f
Wilkinson, James R
48866c95-4389-4ff1-ac68-c4eb6dfc5b87
Curzen, Nicholas
70f3ea49-51b1-418f-8e56-8210aef1abf4

Whittaker, Andrew, Lehal, Manpreet, Calver, Alison L, Corbett, Simon, Deakin, Charles D, Gray, Huon, Simpson, Iain, Wilkinson, James R and Curzen, Nicholas (2016) Predictors of inhospital mortality following out-of-hospital cardiac arrest: insights from a single-centre consecutive case series. Postgraduate Medical Journal, 92 (1087), 250-254. (doi:10.1136/postgradmedj-2015-133575).

Record type: Article

Abstract

PURPOSE OF THE STUDY: Out-of-hospital cardiac arrest (OHCA) has a poor prognosis despite bystander resuscitation and rapid transfer to hospital. Optimal management of patients after arrival to hospital continues to be contentious, especially the timing of emergency coronary angiography±revascularisation. Robust predictors of inhospital outcome would be of clinical value for initial decision-making.

STUDY DESIGN: A retrospective analysis of consecutive patients who presented to a university hospital following OHCA over a 70-month period (2008-2013). Patients were identified from the emergency department electronic patient registration and coding system. For those patients who underwent emergency percutaneous coronary intervention, details were crosschecked with national databases.

RESULTS: We identified 350 consecutive patients who were brought to our hospital following OHCA. Return of spontaneous circulation (ROSC) for >20 min was achieved either before arrival or inhospital in 196 individuals. From the 350 subjects, 114 (32.6%) survived to hospital discharge. When sustained ROSC was achieved, either before or inhospital, survival to discharge was 58.2% (114 of 196). Non-shockable rhythm, absence of bystander cardiopulmonary resuscitation, 'downtime' >15 min and initial pH ≤7.11 were predictors of inhospital death. 12% patients who underwent angiography in the presence of ST elevation had no acute coronary occlusion. 21% patients with acute coronary occlusion at angiography did not have ST elevation.

CONCLUSIONS: In our cohort of patients with OHCA, those who achieve ROSC had a survival-to-discharge rate of 58.2%. We identified four predictors of inhospital death, which are readily available at the time of patient presentation. Reliance on ST elevation to decide about coronary angiography and revascularisation may be flawed. More data are required.

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More information

Accepted/In Press date: 7 December 2015
e-pub ahead of print date: 6 January 2016
Keywords: Aged, Cardiopulmonary Resuscitation/statistics & numerical data, Coronary Angiography/methods, Emergency Medical Services/methods, Female, Hospital Mortality, Humans, Hydrogen-Ion Concentration, Male, Myocardial Infarction/complications, Myocardial Revascularization/methods, Out-of-Hospital Cardiac Arrest/diagnosis, Outcome and Process Assessment (Health Care), Prognosis, Retrospective Studies, Survival Analysis, Time-to-Treatment, United Kingdom/epidemiology

Identifiers

Local EPrints ID: 436087
URI: http://eprints.soton.ac.uk/id/eprint/436087
ISSN: 0032-5473
PURE UUID: 7cf47222-008c-4748-846c-4fc9078d43ca
ORCID for Nicholas Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 27 Nov 2019 17:30
Last modified: 10 Jan 2022 02:50

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Contributors

Author: Andrew Whittaker
Author: Manpreet Lehal
Author: Alison L Calver
Author: Simon Corbett
Author: Huon Gray
Author: Iain Simpson
Author: James R Wilkinson
Author: Nicholas Curzen ORCID iD

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