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

Postgrad Med J. 2016 May;92(1087):250-4. doi: 10.1136/postgradmedj-2015-133575. Epub 2016 Jan 6.

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.

Keywords: ACCIDENT & EMERGENCY MEDICINE.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Cardiopulmonary Resuscitation / statistics & numerical data*
  • Coronary Angiography* / methods
  • Coronary Angiography* / statistics & numerical data
  • Emergency Medical Services / methods
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Hospital Mortality
  • Humans
  • Hydrogen-Ion Concentration
  • Male
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / diagnosis
  • Myocardial Infarction* / epidemiology
  • Myocardial Infarction* / therapy
  • Myocardial Revascularization* / methods
  • Myocardial Revascularization* / statistics & numerical data
  • Out-of-Hospital Cardiac Arrest* / diagnosis
  • Out-of-Hospital Cardiac Arrest* / mortality
  • Out-of-Hospital Cardiac Arrest* / therapy
  • Outcome and Process Assessment, Health Care
  • Prognosis
  • Retrospective Studies
  • Survival Analysis
  • Time-to-Treatment
  • United Kingdom / epidemiology