Cohort study on the factors associated with survival post-cardiac arrest
Keywords:
Cardiac arrest, Cardiopulmonary resuscitation, Survival analysis, Emergency medical services, EpidemiologyAbstract
CONTEXT AND OBJECTIVE: Cardiac arrest is a common occurrence, and even with efficient emergency treatment, it is associated with a poor prognosis. Identification of predictors of survival after cardiopul-monary resuscitation may provide important information for the healthcare team and family. The aim of this study was to identify factors associated with the survival of patients treated for cardiac arrest, after a one-year follow-up period. DESIGN AND SETTING: Prospective cohort study conducted in the emergency department of a Brazilian university hospital. METHODS: The inclusion criterion was that the patients presented cardiac arrest that was treated in the emergency department (n = 285). Data were collected using the In-hospital Utstein Style template. Cox regression was used to determine which variables were associated with the survival rate (with 95% sig-nificance level). RESULTS: After one year, the survival rate was low. Among the patients treated, 39.6% experienced a re-turn of spontaneous circulation; 18.6% survived for 24 hours and of these, 5.6% were discharged and 4.5% were alive after one year of follow-up. Patients with pulseless electrical activity were half as likely to survive as patients with ventricular fibrillation. For patients with asystole, the survival rate was 3.5 times lower than that of patients with pulseless electrical activity. CONCLUSIONS: The initial cardiac rhythm was the best predictor of patient survival. Compared with ven-tricular fibrillation, pulseless electrical activity was associated with shorter survival times. In turn, compared with pulseless electrical activity, asystole was associated with an even lower survival rate.
Downloads
References
Eng Hock Ong M, Chan YH, Anantharaman V, et al. Cardiac arrest and resuscitation epidemiology in Singapore (CARE I study). Prehosp Emerg Care. 2003;7(4):427-33.
Tok D, Keles GT, Toprak V, Topcu I. Assessment of in-hospital cardiopulmonary resuscitation using Utstein template in a university hospital. Tohoku J Exp Med. 2004;202(4):265-73.
Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation in adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58(3):297-308.
Phelps R, Dumas F, Maynard C, Silver J, Rea T. Cerebral Performance Category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013;41(5):1252–7.
Hospital São Paulo – Hospital universitário da UNIFESP. Quem somos. Available from: www.hospitalsaopaulo.org.br/quem-somos. Accessed in 2015 (Aug 11).
Avansi P do A, Meneghin P. Tradução e adaptação para a língua Portuguesa do In-Hospital Utstein style [Translation and adaptation of the In-Hospital Utstein style into the Portuguese language]. Rev Esc Enferm USP. 2008;42(3):504-11.
de-la-Chica R, Colmenero M, Chavero MJ, et al. Factores pronósticos de mortalidad en una cohorte de pacientes con parada cardiorrespiratoria hospitalaria [Prognostic factors of mortality in a cohort of patients with in-hospital cardiorespiratory arrest]. Med Intensiva. 2010;34(3):161-9.
Schneider A, Böttiger BW, Popp E. Cerebral resuscitation after cardiocirculatory arrest. Anesth Analg. 2009;108(3):971-9.
Peberdy MA, Callaway CW, Neumar RW, et al. Part 9: post-cardiacarrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S768-86.
Gräsner JT, Bossaert L. Epidemiology and management of cardiac arrest: what registries are revealing. Best Pract Res Clin Anaesthesiol. 2013;27(3):293-306.
Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6-e245.
Jones DA, DeVita M, Bellomo R. Rapid-response teams. N Engl J Med. 2011;365(2):139-46.
Shin TG, Jo IJ, Song HG, Sim MS, Song KJ. Improving survival rate of patients with in-hospital cardiac arrest: five years of experience in a single center in Korea. J Korean Med Sci. 2012;27(2):146-52.
Gonzalez MM, Timerman S, de Oliveira RG, et al. I Diretriz de Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia: Resumo Executivo [I Guideline for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Brazilian Society of Cardiology: Executive Summary]. Arq Bras Cardiol. 2013;100(2):105-13.
Chan JC, Wong TW, Graham CA. Factors associated with survival after in-hospital cardiac arrest in Hong Kong. Am J Emerg Med. 2013;31(5):883-5.
Kern KB, Timerman S, Gonzalez MM, Ramires JA. Abordagem otimizada na ressuscitação cardiocerebral [Optimized approach in cardiocerebral resuscitation]. Arq Bras Cardiol. 2011;96(4):e77-80.
León Miranda MD, Gómez Jiménez FJ, Martín-Castro C, et al. [Prognostic factors for mortality in out-of-hospital cardiorespiratory arrest]. Med Clin (Barc). 2003;120(15):561-4.
Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33(2):237-45.
Zafari AM, Zarter SK, Heggen V, et al. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol. 2004;44(4):846-52.
Bartholomay E, Dias FS, Torres FA, et al. Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes. Arq Bras Cardiol. 2003;81(2):182-8, 189-95.
Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3(1):63-81.
Kutsogiannis DJ, Bagshaw SM, Laing B, Brindley PG. Predictors of survival after cardiac or respiratory arrest in critical care units. CMAJ. 2011;183(14):1589-95.
Lee HK, Lee H, No JM, et al. Factors influencing outcome in patients with cardiac arrest in the ICU. Acta Anaesthesiol Scand. 2013;57(6):784-92.
Chan PS, Nallamothu BK, Krumholz HM, et al. Long-term outcomes in elderly survivors of in-hospital cardiac arrest. N Engl J Med. 2013;368(11):1019-26.
Vancini-Campanharo CR, Vancini RL, de Lira CA, Atallah ÁN, de Góis AF. Cardiac arrest and epilepsy: what is the role of educational programs for health professionals and caregivers? Epilepsy Behav. 2013;29(2):430.
