Elsevier

Resuscitation

Volume 83, Issue 8, August 2012, Pages 1001-1005
Resuscitation

Clinical paper
Long-term prognosis following resuscitation from out-of-hospital cardiac arrest: Role of aetiology and presenting arrest rhythm

https://doi.org/10.1016/j.resuscitation.2012.01.029Get rights and content

Abstract

Objective

Little is known about long-term prognosis following resuscitation from out-of-hospital cardiac arrest, especially as it relates to the presenting rhythm or arrest aetiology. We investigated long-term survival among those discharged alive following resuscitation according to presenting rhythm and arrest aetiology.

Methods

We conducted a cohort investigation of all non-traumatic adult out-of-hospital cardiac arrest patients resuscitated and discharged alive from hospital between January 1, 2001 and December 31, 2009 in a large metropolitan emergency medical service system. Information about demographics, circumstances, presenting arrest rhythm and aetiology was collected using the dispatch, EMS, and hospital records. Long-term vital status was ascertained using state death records and the Social Security Death Index through 31st December 2010. We used Kaplan Meier to evaluate survival.

Results

During the study period, a total of 1001/5958 (17%) persons were resuscitated and discharged alive, of whom 313/1001 (31%) presented with a non-shockable rhythm and 210/1001 (21%) had a non-cardiac aetiology. Overall median survival was 9.8 years with 64% surviving >5 years. Five-year survival was 43% for non-shockable rhythms compared to 73% for shockable rhythms, and 45% for non-cardiac aetiology compared to 69% for cardiac aetiology (p < 0.001 respectively).

Conclusion

Cardiac arrest due to non-shockable rhythm or non-cardiac aetiology comprises a substantial proportion of those who survive to hospital discharge. Although long-term survival in these groups is less than their shockable or cardiac aetiology counterparts, nearly half are alive 5 years following discharge. The findings support efforts to improve resuscitation care for those with non-shockable rhythms or non-cardiac cause.

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.

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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.

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