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Evolution and Contemporary Predictors of Outcomes in Out-of-Hospital Cardiac Arrest Patients Admitted to Intensive
Rut Andrea1, Marc Izquierdo-Ribas2, Esther Sanz3
1Acute Cardiac Care Section, Cardiovascular Institute, Hospital Clínic de Barcelona and University of Barcelona, Barcelona, Spain; Institut d'Investigacions biomèdiques Auguts Pi i Sunyer, Barcelona, Spain.
Insights
Nearly half of out-of-hospital cardiac arrest (OHCA) patients achieved favorable neurological outcomes at six months. Pre-hospital factors significantly predicted outcomes, highlighting the need for standardized care protocols for cardiac arrest survivors.
Area of Science:
- Cardiology
- Emergency Medicine
- Neurology
Background:
- Out-of-hospital cardiac arrest (OHCA) is a major cause of cardiovascular death.
- Current understanding of how modern treatments affect long-term OHCA patient outcomes is limited.
Purpose of the Study:
- To investigate the characteristics, treatment variations, and 6-month outcomes of OHCA patients in intensive cardiovascular care units.
- To identify predictors of neurological outcomes in OHCA patients.
Main Methods:
- Prospective multicenter registry of OHCA patients admitted to intensive cardiovascular care units (October 2020 - December 2021).
- Patients categorized by Cerebral Performance Category (CPC) score (1-2 for favorable, 3-5 for non-favorable/death).
- Multinomial logistic regression used to determine independent predictors of CPC 3-5.
Main Results:
- 49% of patients had a favorable neurological outcome (CPC 1-2) at 6 months.
- Older age, male sex, prior stroke, prolonged time to return of spontaneous circulation (ROSC), and non-shockable rhythm predicted poor outcomes (CPC 3-5).
- Significant variability observed in post-resuscitation care, including targeted temperature management and coronary angiography.
Conclusions:
- Almost half of OHCA patients achieved favorable neurological outcomes at 6 months, with outcomes persisting.
- Pre-hospital factors, not in-hospital interventions, were the strongest predictors of neurological outcome.
- Variability in care highlights the need for standardized protocols and dedicated cardiac arrest centers.
Background:
Out-of-hospital cardiac arrest (OHCA) remains a leading cause of cardiovascular mortality, yet significant gaps persist in understanding how contemporary management strategies influence long-term outcomes.
Aim:
We sought to provide novel insights into the characteristics, management variability, and 6-month outcomes of patients with OHCA admitted to eight intensive cardiovascular care units during a contemporary period.
Method:
This was a prospective multicentre registry of patients with OHCA admitted to intensive cardiovascular care units from October 2020 to December 2021. Patients were categorised by prognosis as either favourable outcome (Cerebral Performance Category [CPC] 1-2) or non-favourable outcome, including death (CPC 3-5). A multinomial logistic regression identified independent predictors of CPC 3-5.
Results:
Among 288 patients, only 17.36% were women. Most arrests (88.93%) were witnessed, yet bystander cardiopulmonary resuscitation was initiated in just 69.18% of cases. Despite 80% of patients presenting with a shockable rhythm, an automated external defibrillator was used in only 58%. Median time to return of spontaneous circulation (ROSC) was 28 minutes. Marked variability in post-resuscitation care was observed across centres in the use of targeted temperature management, emergent coronary angiography, and multimodal neuroprognostication. At 6 months, 49% of patients exhibited CPC 1-2. Ninety-three per cent of discharged patients maintained a favourable neurological outcome, and 15% improved their CPC score. Independent predictors of CPC 3-5 included older age (p=0.005), male sex (p=0.016), previous stroke (p=0.046), prolonged time to ROSC (p<0.001), and a non-shockable initial rhythm (p<0.001). Hypoxic-ischaemic brain injury was the leading cause of in-hospital death (72.90%).
Conclusions:
Nearly half of the patients with OHCA survived with a favourable neurological outcome, which persisted after 6 months. Despite significant in-hospital interventions, pre-hospital factors remained the strongest predictors of neurological outcome. The high degree of management variability suggests an urgent need for standardised protocols and supports the creation of cardiac arrest centres.
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