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Effects of pre-arrest comorbidities on 90-day survival of patients resuscitated from out-of-hospital cardiac arrest
  1. Chien-Chang Lee1,2,
  2. Min-Shan Tsai1,
  3. Cheng-Chung Fang1,
  4. Yi-Jung Chen1,
  5. Matthew Hui-Ming1,
  6. Chien-Hwua Huang1,3,
  7. Wen-Jone Chen1,
  8. Shyr-Chyr Chen1
  1. 1Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
  2. 2Department of Epidemiology, Harvard School of Public Health, Boston, USA
  3. 3Division of Intensive Care Unit, Department of Emergency Department, National Taiwan University, Taipei, Taiwan
  1. Correspondence to Shyr-Chyr Chen, Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7 Chun-Shan South Road, Taipei 100, Taiwan; scchen{at}ntu.edu.tw

Abstract

Background Factors that affect prognosis in successfully resuscitated out-of-hospital cardiopulmonary arrest (OHCA) patients in the intensive care unit (ICU) who survived the initial 24 h period of post-resuscitation have not been established. This study was conducted to evaluate the clinical prognostic factors associated with 90-day survival in patients who were successfully resuscitated from OHCA.

Methods This study was conducted at a tertiary large university hospital. Clinical data were obtained from the medical records of 224 adult non-traumatic patients who were successfully resuscitated from OHCA and who survived the initial 24 h post-resuscitation phase. Univariate and multivariate analyses were performed to identify independent predictors associated with 90-day survival.

Results Significant adverse prognosticators included liver cirrhosis (HR 4.36, 95% CI 1.76 to 10.79), prolonged cardiopulmonary resuscitation (CPR) duration >20 min (HR 1.95, 95% CI 1.27 to 3.00) and underlying malignancy (HR 1.64, 95% CI 1.06 to 2.54). Favourable prognostic factors included the best Glasgow Coma Scale within 24–48 h after return of spontaneous circulation >5 (HR 0.16, 95% CI 0.04 to 0.68), mean arterial pressure on ICU admission >100 mmHg (HR 0.81, 95% CI 0.43 to 0.94) and the presenting rhythm of pulseless electrical activity (HR 0.44, 95% CI 0.1 to 0.63). A high burden of comorbidities (by Charlson score >5) was associated with significantly poorer 90-day survival (HR 1.60, 95% CI 1.03 to 2.49).

Conclusions Underlying comorbidities have a significant influence on survival. CPR duration, post-resuscitative blood pressure and early neurological recovery may serve as practical clinical predictors of short-term survival.

  • Out-of-hospital cardiopulmonary arrest
  • survival
  • resuscitation
  • comorbidity
  • blood pressure
  • Glasgow coma scale
  • nursing
  • emergency departments

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Footnotes

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the National Taiwan University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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