Clinical paperLong-term prognosis following resuscitation from out-of-hospital cardiac arrest: Role of aetiology and presenting arrest rhythm☆
Introduction
Out-of hospital cardiac arrest is a leading cause of mortality worldwide.1, 2 Considerable programmatic and research efforts are directed towards improving resuscitation.3, 4, 5, 6, 7 Often these efforts focus on arrest due to cardiac aetiology or those who present with a shockable arrest rhythm. These groups are considered those most likely to benefit from the links in the chain of survival, and so in turn may constitute the majority of meaningful survival.8, 9, 10
The epidemiology of cardiac arrest is changing however. About three-quarters of all arrests present with a non-shockable rhythm and upwards of a third of arrests are due to a non-cardiac cause when the aetiology is rigorously evaluated.11, 12, 13 Moreover, even though those with non-cardiac aetiology or a non-shockable arrest rhythm are more difficult to resuscitate, the proportion who survive to hospital discharge can be substantial given they comprise an increasing proportion of arrest victims.14, 15, 16, 17
Literature about long-term prognosis following resuscitation and hospital discharge remains limited, especially as it relates to presenting arrest rhythm or arrest aetiology. Long-term survival provides an important context for how to expend limited resources aimed at improving resuscitation. If prognosis is especially poor among those with non-cardiac aetiology or non shockable rhythms, one may focus resuscitation developments and reporting among cardiac aetiology or shockable rhythms for whom the attributable public health benefit may be optimal. Conversely favourable long-term prognosis among non-cardiac aetiology or non-shockable rhythms could support resuscitation efforts that invest, evaluate, and attempt to improve care in these subgroups.18, 19, 20, 21 We investigated long-term prognosis among a population-based cohort discharged alive from the hospital following resuscitation from out-of-hospital cardiac arrest. We compared prognosis according to arrest aetiology and initial arrest rhythm.
Section snippets
Study design, setting, and population
The investigation was approved by the appropriate Review Boards. We performed a cohort investigation of all non-traumatic cardiac arrests that were resuscitated and discharged alive from hospital between January 1, 2001 and December 31, 2009 in a large metropolitan emergency medical service (EMS) system. The EMS system serves a population of approximately 1.3 million persons residing in urban, suburban, and rural settings covering an area of about 2000 square miles. The EMS is a two-tiered
Results
Between January 1, 2001 and December 31 2009, 6742 persons suffered out-of-hospital cardiac arrest and received attempted resuscitation from the EMS (Fig. 1). A total of 784 were not eligible. Of the remaining 5958 potentially eligible, 1001 (17%) were discharged alive from the hospital and included in the study cohort. Among the study cohort, the arrest aetiology was non-cardiac for 210/1001 (21%), and the presenting arrest rhythm was non-shockable for 313/1001 (31%) (Fig. 1). The most common
Discussion
In this population-based cohort study of persons who survived out-of-hospital cardiac arrest and were discharged alive from the hospital, those with non-cardiac aetiology and non-shockable arrest rhythm comprised 21% and 31% of survivors respectively. Long-term survival was lower in these groups than their counterparts with cardiac aetiology and/or shockable arrest rhythm. Nonetheless, survival among non-cardiac aetiology and non-shockable arrest rhythm groups was about 65% at 1 year and nearly
Conclusion
In conclusion, cardiac arrest due to a non-shockable rhythm or non-cardiac aetiology comprises a substantial proportion of those who survive and are discharged alive from the hospital. Although long-term survival in these groups is less than their shockable or cardiac aetiology counterparts, nearly half are alive 5 years following hospital discharge, a finding that supports continued efforts to improve resuscitation care for all patients with cardiac arrest including those with non-cardiac
Conflict of interest statement
None to disclose.
Acknowledgements
We wish to thank the dispatchers and EMS providers of the study community for their efforts directed towards resuscitation and programmatic evaluation.
References (34)
- et al.
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A scientific statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke
Resuscitation
(2008) - et al.
Overcoming frustration about neutral clinical studies in cardiopulmonary resuscitation
Resuscitation
(2009) - et al.
Epidemiology, trends, and outcome of out-of-hospital cardiac arrest of non-cardiac origin
Resuscitation
(2007) - et al.
Incidence of EMS-treated out-of-hospital cardiac arrest in the United States
Resuscitation
(2004) - et al.
Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community
J Am Coll Cardiol
(2004) - et al.
Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden
Resuscitation
(2004) - et al.
Factors affecting short- and long-term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity
Resuscitation
(2001) - et al.
Characteristics and outcome in out-of-hospital cardiac arrest when patients are found in a non-shockable rhythm
Resuscitation
(2008) - et al.
Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms
Resuscitation
(2011) - et al.
Long-term survival after out-of-hospital cardiac arrest
Resuscitation
(2007)
Importance of time-to-reperfusion in patients with acute myocardial infarction with and without cardiogenic shock treated with primary percutaneous coronary intervention
Am Heart J
The effect of experience of on-site physicians on survival from prehospital cardiac arrest
Resuscitation
Does therapeutic hypothermia benefit adult cardiac arrest patients presenting with non-shockable initial rhythms?: a systematic review and meta-analysis of randomized and non-randomized studies
Resuscitation
Heart disease and stroke statistics – 2010 update: a report from the American Heart Association
Circulation
Regional variation in out-of-hospital cardiac arrest incidence and outcome
JAMA
Community approaches to improve resuscitation after out-of-hospital sudden cardiac arrest
Circulation
Advanced cardiac life support in out-of-hospital cardiac arrest
N Engl J Med
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2012.01.029.