To identify the independent predictors of survival to hospital discharge in the group of patients admitted to hospital with out-of-hospital cardiac arrest.
Design
Prospective cohort study.
Setting
Two public hospitals in a cluster in Hong Kong.
Methods
Data were reported to local Cardiac Arrest Registry using Utstein style template from 1st August 2010 to 31st October 2012. The post cardiac arrest care and outcome, premorbid mobility, activities of daily living (ADL) and medical illnesses were traced from medical records. Independent predictors were calculated using logistic regression model.
Results
A total of 323 patients were recruited in this study. Patients' age (Odds raio [OR]=0.966; 95% confidence interval [CI]=0.937-0.996), total down time (OR=0.897; 95% CI=0.858-0.938), pre-hospital defibrillation (OR=5.649; 95% CI=1.673-19.07), post-cardiac arrest intensive care (OR=3.674; 95% CI=1.001-13.951) were independent predictors of survival to hospital discharge.
Conclusions
Younger age, shorter down time, prehospital defibrillation for shockable rhythm, post-cardiac arrest intensive care are independent predictors of survival to discharge for patients admitted to hospital after out-of-hospital cardiac arrest. Premorbid health conditions, ADL and mobility are not predictors to patient's survival. (Hong Kong j.emerg.med. 2014;21:131-139)
ValenzuelaT.D., ToeD.J., CretinS., SpaiteD.W., LarsenM.P.Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation1997; 96(10): 3308–13.
2.
WestonC.F., WilsonR.J., JonesS.D.Predicting survival from out-of-hospital cardiac arrest: a multivariate analysis. Resuscitation1997; 34(1): 27–34.
3.
MarwickT.H., CaseC.C., SiskindV., WoodhouseS.P.Prediction of survival from resuscitation: a prognostic index derived from multivariate logistic model analysis. Resuscitation1991; 22(2): 129–37.
4.
StiellI.G., WellsG.A., FieldB.J., SpaiteD.W., De MaioV.J., WardR.Improved out-of-hospital cardiac arrest susvival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA1999; 281(13): 1175–81.
5.
SworR.A., JacksonR.E., CynarM., SadlerE., BasseE., BojiB.Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest. Ann Emerg Med1995; 25(6): 780–4.
6.
LeungK.L., LuiC.T., CheungK.H., TsuiK.L., TangY.H.Outcome and prognostic factors of patients in out-of-hospital cardiac arrests presenting with non-shockable rhythm in Hong Kong. Hong Kong J Emerg Med2012; 19(1): 6–12.
7.
ChanT.H., LuiC.T., CheungK.H., TangY.H., TsuiK.L.Outcome predictors of patients in out-of-hospital cardiac arrests with pre-hospital defibrillation in Hong Kong. Hong Kong J Emerg Med2013; 22(3): 131–7.
8.
DeLongE.R., DeLongD.M., Clarke-PearsonD.L.Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics1988; 44(3): 837–45.
9.
ChanT.K., WanK.A., ChanJ.C.K., LamH.K.C., WongY.T., KanP.G.New era of CPR: application of i-technology in resuscitation. Hong Kong J Emerg Med2012; 19(5): 305–11.
10.
ReynoldsJ.C., LawnerB.J.Management of the post-cardiac arrest syndrome. J Emerg Med2012; 42(4): 440–9.
11.
KirvesH., SkrifvarsM.B., VahakuopusM., EkstromK., MartikainenM., CastrenM.Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients. Eur J Emerg Med2007; 14(2): 75–81.
12.
SundeK., PytteM., JacobsenD., MangschauA., JensenL.P., SmedsrudC.Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation2007; 73(1): 29–39.
13.
GaieskiD.F., BandR.A., AbellaB.S., NeumarR.W., FuchsB.D., KolanskyD.M.Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation2009; 80(4): 418–24.
14.
PeberdyM.A., CallawayC.W., NeumarR.W., GeocadinR.G., ZimmermanJ.L., DonninoM.Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation2010; 122(18): 768–86.
15.
The Hypothermia after Cardiac Arrest Study Group.Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med2002; 346(8): 549–56.
16.
BernardS.A., GrayT.W., BuistM.D., JonesB.M., SilvesterW., GutteridgeG.Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med2002; 346(8): 557–63.
17.
NolanJ.P., MorleyP.T., Vanden HoekT.L., HickeyR.W., KloeckW.G., BilliJ.International Liaison Committee on Resuscitation. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation2003; 108(1): 118–21.
18.
ArrichJ., HelzerM., HerknerH., MullnerM.Hypothermia for neuroprotection in adults after cardiopulmonary resusciation. Cochrane Database Syst Rev2009; 4: CD004128.
De VosR., KosterR.W., De HaanR.J., OostingH., Van der WouwP.A., Lampe-SchoenmaeckersA.J.In-hospital cardiopulmonary resuscitation: prearrest morbidity and outcome. Arch Intern Med1999; 159(8): 845–50.
21.
LeeC.C., TsaiM.S., FangC.C., ChenY.J., MatthewH.M., HuangC.H.Effects of pre-arrest comorbidities on 90-day survival of patients resuscitated from out-of-hospital cardiac arrest. Emerg Med J2011; 28(5): 432–6.
22.
NarainP., RubensteinL.Z., WielandG.D., RosbrookB., StromeL.S., PietruszkaF.Predictors of immediate and 6-month outcomes in hospitalized elderly patients. The importance of functional status. J Am Geriatr Soc1988; 36(9): 775–83.
23.
CovinskyK.E., JusticeA.C., RosenthalG.E., PalmerR.M., LandefeldC.S.Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med1997; 12(4): 203–8.
24.
PonzettoM., MaeroB., MainaP., PosatoR., CicconeG., MariettiF.Risk factors for early and late mortality in hospitalized older patients: the continuing importance of functional status. J Gerontol A Biol Sci Med Sci2003; 58(11): 1049–54.
25.
CampbellS.E., SeymourD.G., PrimroseW.R.A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing2004; 33(2): 110–5.
26.
ThomasD.R., KamelH., AzharrudinM., AliA.S., KhanA., JavaidU., MorleyJ.E.The relationship of functional status, nutritional assessment, and severity of illness to in-hospital mortality. J Nutr Health Aging2005; 9(3): 169–75.
