Outcome after ICU admission following out-of-hospital cardiac arrest in a UK teaching hospital

Introduction

Outcome after out-of-hospital cardiac arrest is poor [1]. We examined the records of patients admitted to the University Hospital of Wales ICU to compare our outcomes with published literature and to identify risk factors for poor outcome.

Methods

All patients aged >18 years who were admitted between 1 January 2004 and 31 December 2006 after out-of-hospital cardiac arrest were identified from computerised records and case notes. Patients admitted between 1 January 2007 and 31 May 2007 were studied prospectively. Demographic and outcome data were collected as well as information related to the cardiac arrest episode.

Results

Sixty patients were admitted over 41 months. Twenty-one out of 60 were female (male:female ratio 2:1). The mean age was 61.8 ± 15.2 years. There were six patients >80 years old. Bystander cardiopulmonary resuscitation (CPR) was attempted in 73% of cases. The response time of medical services ranged from 3 to 45 minutes (mean 10.5, median 7 min). The longest response time for a surviving patient was 6 minutes. No patient survived with a total duration of cardiac arrest >15 minutes or time without CPR >6 minutes. There were no survivors with any initial rhythm other than ventricular fibrillation/ventricular tachycardia (VF/VT). The mean ICU length of stay was 3.3 days for nonsurvivors (range 1–15 days) and 12.9 days (range 1–35 days) for survivors. Mean hospital length of stay was 4.4 days for nonsurvivors (range 1–35 days) and 31.4 days (range 1–91 days) for survivors. Overall survivals to ICU/home discharge were 38.3%/33.3%, respectively. Survival in the >80-year-old group was 0% compared with 40% in those aged <80 years (P = 0.024). Survival in males was 38.5% and in females 23.8% (P = 0.25). Information on neurological outcome was available for seven out of 20 survivors. All seven received therapeutic hypothermia treatment. Five (71%) had 'good' neurological outcomes. One had minor cognitive deficit and one required long-term nursing home care.

Conclusion

The high male:female ratio may reflect the higher incidence of ischaemic heart disease in males. Gender does not affect outcome after ICU admission. Our survival rates of 33.3% are higher than the national average of 28.6% [1], but we have had no survivors over the age of 80 years or with any initial rhythm other than VF/VT. Delay to initiation of CPR (>6 min) and prolonged CPR (>15 min) were also universally associated with death in this patient cohort. Neurological outcomes of survivors appear good.