Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management

TY - JOUR

T1 - Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management

AU - Salam, Idrees

AU - Thomsen, Jakob Hartvig

AU - Kjaergaard, Jesper

AU - Bro-Jeppesen, John

AU - Frydland, Martin

AU - Winther-Jensen, Matilde

AU - Køber, Lars

AU - Wanscher, Michael

AU - Hassager, Christian

AU - Søholm, Helle

PY - 2018/5/4

Y1 - 2018/5/4

N2 - Objective. Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM). Design. Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002–2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI). Results. A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p <.001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p <.001, witnessed: 79% vs. 90%, p <.001, bystander CPR: 47% vs. 63%, p <.001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2–2.9), p <.01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55–1.2), p =.34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present. Conclusion. A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm.

AB - Objective. Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM). Design. Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002–2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI). Results. A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p <.001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p <.001, witnessed: 79% vs. 90%, p <.001, bystander CPR: 47% vs. 63%, p <.001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2–2.9), p <.01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55–1.2), p =.34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present. Conclusion. A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm.

KW - Aged

KW - Body Temperature Regulation

KW - Cardiopulmonary Resuscitation/adverse effects

KW - Coma/diagnosis

KW - Comorbidity

KW - Denmark

KW - Electric Countershock/adverse effects

KW - Female

KW - Heart Rate

KW - Humans

KW - Hypothermia, Induced/adverse effects

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Out-of-Hospital Cardiac Arrest/diagnosis

KW - Proportional Hazards Models

KW - Registries

KW - Retrospective Studies

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1080/14017431.2018.1450991

DO - 10.1080/14017431.2018.1450991

M3 - Journal article

C2 - 29553891

SN - 1401-7458

VL - 52

SP - 133

EP - 140

JO - Scandinavian Cardiovascular Journal, Supplement

JF - Scandinavian Cardiovascular Journal, Supplement

IS - 3

ER -