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Predictors of poor outcome in out-of-hospital cardiac arrest
Critical Care volume 18, Article number: P489 (2014)
Out-of-hospital cardiac arrest (OOHCA) causes 60,000 UK and 300,000 US deaths each year. Survival to hospital discharge in the developed world has historically been 7 to 10% with obvious cognitive impairment in 10% of survivors. Primary percutaneous coronary intervention (PPCI) and targeted temperature management (TTM) (or at least hyperthermia avoidance) have been shown to improve survival in comatose patients post OOHCA. There is no reliable method to predict poor outcome on presentation. We aimed to identify factors associated with poor outcome in our single-centre regional referral OOHCA population.
We performed a pragmatic single-centre retrospective review over 18 months commencing 1 January 2011 of all patients admitted to our regional OOHCA centre ICU following successful resuscitation from OOHCA. In keeping with guidelines, all patients were assessed for suitability for PPCI and TTM. A good outcome was defined by a Pittsburgh Cognitive Performance Category (CPC) score of 1 to 2 (independence, mild impairment) on hospital discharge. A poor outcome was defined as death or CPC 3 to 4 (moderate to severe impairment, coma) on hospital discharge. CPC scoring was determined from physiotherapy and occupational therapy assessments in the clinical notes. Continuous data were analysed using a two-tailed t test or Mann-Whitney U test, categorical data with a chi-squared test.
Sixty-nine patients were admitted to our ICU following successful resuscitation from OOHCA in the 18-month period. Presenting features and outcomes are shown in Table 1.
Good outcome was associated with a shockable rhythm on presentation, cardiac cause, arrest occurring in daylight hours (08:00 to 20:00) and shorter time between collapse and ROSC. Poor outcome was associated with placement of an advanced airway device, lower pH, higher base deficit and higher lactate.
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Petrie, J., Brett, S. & Stümpfle, R. Predictors of poor outcome in out-of-hospital cardiac arrest. Crit Care 18, P489 (2014). https://doi.org/10.1186/cc13679
- Cardiac Arrest
- Hospital Discharge
- Occupational Therapy
- Primary Percutaneous Coronary Intervention
- High Base