[Prognosis of patients admitted to the coronary or intensive care unita after an out of hospital episode of sudden death]

Mortality after out-of-hospital cardiac arrest in a Spanish Region

AIMS

To determine out-of-hospital cardiac arrest mortality in the province of Alicante (Spain) and its associated factors.

METHODS

Cross-sectional observational study of all patients who received cardiopulmonary resuscitation (CPR) by the Emergency Medical Services (EMS) (n = 422) in the province of Alicante in 2013. To determine associated factors, a binary logistic regression model was constructed. Primary outcome: death before arriving at the hospital. Predictive variables: gender, age, artificial respiration, prior functional status, asystole, cardiogenic aetiology, bystander CPR, time from the cardiac arrest to the arrival of the EMS and location of cardiac arrest.

RESULTS

There were 337 deaths (79.9%; 95% CI: 76.0-83.7%). Factors independently associated (p<0.05) with death were: male gender (OR = 2.11; 95% CI: 1.20-3.72; p = 0.010), asystole (OR = 1.99, 95% CI: 1.17-3.39; p = 0.012), cardiac arrest at home (OR = 2.44; 95% CI: 1.42-4.18; p = 0.001) and an increased time between arrest and EMS arrival (OR = 1.05, 95% CI: 1.01-1.09, p = 0.009). Having a worse prior functional status had a tendency towards significance (OR = 0.56, 95% CI: 0.31-1.02, p = 0.059).

CONCLUSIONS

Mortality was high. The associated factors were: male gender, asystole, worse prior functional status, longer time from the cardiac arrest to the arrival of the EMS and having the cardiac arrest at home. The clearly negative impact of experiencing a cardiac arrest at home necessitates modifying training policies in Spain. These policies should be focused on providing information about CPR in schools in order to decrease the mortality of these events.

Update on ischemic heart disease and critical care cardiology

This article summarizes the main developments reported in 2013 on ischemic heart disease, together with the most important innovations in the management of acute cardiac patients.

Clinical characteristics and vital and functional prognosis of out-of-hospital cardiac arrest survivors admitted to five cardiac intensive care units

INTRODUCTION AND OBJECTIVES

Survivors of out-of-hospital cardiac arrest constitute an increasing patient population in cardiac intensive care units. Our aim was to characterize these patients and determine their vital and functional prognosis in accordance with the latest evidence.

METHODS

A multicenter, prospective register was constructed with information from patients admitted to 5 cardiac intensive care units from January 2010 through January 2012 with a diagnosis of resuscitated out-of-hospital cardiac arrest. The information included clinical status, cardiac arrest characteristics, in-hospital course, and vital and neurologic status at discharge and at 6 months.

RESULTS

A total of 204 patients were included. In 64% of cases, a first shockable rhythm was identified. The time to return of spontaneous circulation was 29 (18) min. An etiologic diagnosis was made in 86% of patients; 44% were discharged with no neurologic sequelae; 40% died in the hospital. At 6 months, 79% of survivors at discharge were still alive and neurologically intact with minimal sequelae. Short resuscitation time, first recorded rhythm, pH on admission >7.1, absence of shock, and use of hypothermia were the independent variables associated with a good neurologic prognosis.

CONCLUSIONS

Half the patients who recovered from out-of-hospital cardiac arrest had good neurologic prognosis at discharge, and 79% of survivors were alive and neurologically intact after 6 months of follow-up.

[Prognosis of patients admitted in a coronary care unit after resucitating from out-of-hospital sudden cardiac death]

BACKGROUND AND OBJECTIVE

The aims of the present study were to analyze the prognosis after resuscitation from out-of-hospital sudden cardiac death in patients admitted to the coronary care unit, and to identify the predictor variables of morbi-mortality.

PATIENTS AND METHOD

From November 1999 to January 2004 we analyzed 63 patients (47 males) aged 61 +/- 12 years who were admitted to the coronary care unit following successful resuscitation from sudden cardiac death. The clinical and electrocardiographic characteristics were correlated with the mortality and neurological impairment.

RESULTS

Thirty-five patients (55.5%) were discharged, while twenty-eight patients (45.5%) died 28 +/- 4 days after admission, most of them during hospitalization. The main underlying disorder was coronary artery disease (80.9%). When survivors and non-survivors were compared, the variables associated with a worse prognosis were diabetes mellitus (68.4% vs 17.1%, P < .02), the presence of valvular heart disease (28.6% vs 0%, p < 0.003), chronic atrial fibrillation (42.9% vs 14.3%, P < .02) and asystole as the initial rhythm observed (42.9% vs 11.4%, P < .01). Multivariate analysis identified asystole as an independent factor of poor prognosis (P < .02). Death was due to severe postanoxic neurological damage in 23 of 28 deaths (82.1%). The remaining 5 patients died due to their underlying cardiac disease (P < .01). The variables associated with neurological damage were out-of hospital resuscitation, delay in beginning resuscitation maneuvers, arrival time > 5 minutes and unconsciousness on admission.

CONCLUSIONS

Although many patients survive following resuscitation from out-of-hospital sudden cardiac death, mortality remains high. Neurological impairment is the main cause of mortality. Prognosis is determined by the variables related to the underlying disease, the delay in onset of resuscitation maneuvers and postanoxia cerebral damage.

Encefalopatía postanoxémica tras un episodio de muerte súbita cardíaca recuperada

INTRODUCTION AND OBJECTIVES

The presence of post-anoxic encephalopathy after an episode of aborted sudden cardiac death is a serious medical and social problem.

PATIENTS AND METHOD

Of 193 patients admitted to the coronary unit during a 12-year period with aborted sudden cardiac death, 104 died (54%) and 89 survived the episode (46%). We compared the characteristics and 6-month prognosis between survivors according to the presence or absence of post-anoxic encephalopathy.

RESULTS

Of 89 survivors, 38 patients were discharged alive with post-anoxic encephalopathy (42%) and 51 were discharged without neurological disturbances (58%). Patients with post-anoxic encephalopathy were older (65 13.6 vs. 59 12.9 years; p = 0.04). Mean time to care for cardiac arrest was 11.14.9 min in the post-anoxic encephalopathy group, versus 3.43 min (p < 0.01). The first documented rhythm was VF/VT in 57% and asystolia in 29% in the post-anoxic encephalopathy group, vs. 88% and 3% (p = 0.02). More than half (58%) of the patients in the post-anoxic encephalopathy group had coronary artery disease, vs. 49% (p = NS). Slightly more than half (52%) of the patients in the post-anoxic encephalopathy group had infectious complications, vs. 21% (p = 0.01). After 6 months of follow-up, mortality in patients discharged with post-anoxic encephalopathy was 62%, vs. 10% (p < 0.01); 21% of then showed significant functional improvement and 18% remained neurologically stable.

CONCLUSIONS

Most patients admitted to a coronary unit with aborted sudden cardiac death died during hospitalization. Almost half of the survivors had post-anoxic encephalopathy at discharge; of these patients, 62% died within the following 6 months, and functional status improved only in a minority of them.