Epidemiology and outcomes of anaphylaxis-associated out-of-hospital cardiac arrest

PLoS One. 2018 Mar 26;13(3):e0194921. doi: 10.1371/journal.pone.0194921. eCollection 2018.

Abstract

Background: Understanding the epidemiological characteristics of anaphylaxis-associated out-of-hospital cardiac arrest (OHCA) is the first step toward developing preventative strategies and optimizing care systems. We aimed to describe and compare epidemiological features and clinical outcomes among patients with anaphylaxis-associated OHCAs according to causative agent groups.

Methods: We identified emergency medical service (EMS)-treated anaphylaxis-associated OHCA patients from a nationwide OHCA registry between 2008 and 2015. We compared epidemiological characteristics and outcomes according to causal agents (a natural agents group and an iatrogenic agents group) and evaluated temporal variability in incidence. Multivariate logistic regression analysis was performed to compare survival to discharge between causative agent groups.

Results: During the study period (8 years), the total number of anaphylaxis-associated OHCAs was 233. A total of 224 eligible cases were included in the analysis. There were 192 patients (85.6%) in the natural agents group and 32 patients (14.3%) in the iatrogenic agents group. There was significant diurnal and seasonal variability in the frequency of anaphylaxis-associated OHCAs (p values<0.01 for both), with the highest incidences occurring during the day (7:01 am to 3 pm; 64.6%) and in summer (June to August, 48.7%). Compared with the natural agents group, the adjusted odds ratio (AOR) for survival to discharge in the iatrogenic agents group was statistically insignificant (AOR 3.61, 95% CI 0.86 to 15.06).

Conclusion: The incidence of anaphylaxis-associated OHCA is considerably low, and significant temporal variability, with a peak during the day and in summer, is evident. Anaphylaxis-associated OHCA is more common by natural agents than by iatrogenic agents, but no difference in the survival-to-discharge rate is evident.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anaphylaxis / complications*
  • Electrocardiography
  • Emergency Medical Services
  • Female
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Out-of-Hospital Cardiac Arrest / epidemiology*
  • Out-of-Hospital Cardiac Arrest / etiology
  • Out-of-Hospital Cardiac Arrest / mortality
  • Patient Discharge
  • Seasons
  • Survival Rate
  • Time Factors
  • Young Adult

Grants and funding

This study was financially supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (Grant No.:2009-E00543-00, 2010-E33022-00, 2011-E33004-00, 2012-E33010-00, 2013-E33015-00, 2014-E33011-00)(Sang Do Shin). This work was supported by the Dongguk University Research Fund of 2017(Seung Chul Lee). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.