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A Comparison of Prognostic Factors in a Large Cohort of In-Hospital and Out-of-Hospital Cardiac Arrest Patients
Rossana Soloperto1,2, Federica Magni1,3, Anita Farinella1,4
1Department of Intensive Care, Brussels University Hospital (HUB), Free University of Brussels (ULB), 1070 Brussels, Belgium.
Insights
Predicting neurological outcome after cardiac arrest (CA) requires understanding key factors. This study identified similar predictors for in-hospital CA (IHCA) and out-of-hospital CA (OHCA) patients, highlighting vulnerability in hospitalized individuals.
Area of Science:
- Cardiology
- Neurology
- Intensive Care Medicine
Background:
- Cardiac arrest (CA) survivors face significant risks of poor neurological outcomes.
- Differentiating predictors between in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) is crucial for targeted interventions.
- Understanding these factors aids in improving patient management and prognosis.
Purpose of the Study:
- To identify independent factors predicting neurological outcome and death in both IHCA and OHCA patients.
- To compare these predictive factors between the two distinct CA populations.
- To enhance the understanding of post-CA neurological prognostication.
Main Methods:
- A retrospective analysis of adult CA survivors admitted to a mixed Intensive Care Department between 2004 and 2022.
- Collection of demographic data, comorbidities, CA characteristics, ICU treatments, complications, and 3-month neurological outcomes (Cerebral Performance Category scale).
- Multivariable analysis to determine independent predictors of unfavorable neurological outcomes in IHCA and OHCA groups.
Main Results:
- In IHCA patients (n=540), predictors of poor outcome included longer time to return of spontaneous circulation (ROSC), older age, unwitnessed CA, higher admission lactate, asystole, non-cardiac cause, shock, acute kidney injury (AKI), prior neurological disease, and liver cirrhosis.
- In OHCA patients (n=567), predictors included longer time to ROSC, older age, higher admission lactate, unwitnessed CA, asystole/pulseless electrical activity (PEA), shock, non-cardiac cause, and prior neurological disease.
- Minimal differences in predictors were observed between IHCA and OHCA groups.
Conclusions:
- Numerous factors independently predict poor neurological outcomes in both IHCA and OHCA patients.
- The findings suggest greater vulnerability among hospitalized patients, despite largely similar predictive factors.
- These insights can inform clinical decision-making and prognostic assessments for cardiac arrest survivors.
Abstract:
We investigated independent factors predicting neurological outcome and death, comparing in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. The study was conducted in the mixed 34-bed Intensive Care Department at the Hôpital Universitaire de Bruxelles (HUB), Belgium. All adult consecutive cardiac arrest (CA) survivors were included between 2004 and 2022. For all patients, demographic data, medical comorbidities, CA baseline characteristics, treatments received during Intensive Care Unit stay, in-hospital major complications, and neurological outcome at three months after CA, using the Cerebral Performance Category (CPC) scale, were collected. In the multivariable analysis, in the IHCA group (n = 540), time to return of spontaneous circulation (ROSC), older age, unwitnessed CA, higher lactate on admission, asystole as initial rhythm, a non-cardiac cause of CA, the occurrence of shock, the occurrence of acute kidney injury (AKI), and the presence of previous neurological disease and of liver cirrhosis were independent predictors of an unfavorable neurological outcome. Among patients with OHCA (n = 567), time to ROSC, older age, higher lactate level on admission, unwitnessed CA, asystole or pulseless electrical activity (PEA) as initial rhythm, the occurrence of shock, a non-cardiac cause of CA, and a previous neurological disease were independent predictors of an unfavorable neurological outcome. To conclude, in our large cohort of mixed IHCA and OHCA patients, we observed numerous factors independently associated with a poor neurological outcome, with minimal differences between the two groups, reflecting the greater vulnerability of hospitalized patients.
