Severity of chronic obstructive pulmonary disease and presenting rhythm in patients with out-of-hospital cardiac arrest

TY - JOUR

T1 - Severity of chronic obstructive pulmonary disease and presenting rhythm in patients with out-of-hospital cardiac arrest

AU - Granfeldt, Asger

AU - Wissenberg, Mads

AU - Hansen, Steen Møller

AU - Lippert, Freddy K

AU - Torp-Pedersen, Christian

AU - Skaarup, Søren Helbo

AU - Andersen, Lars W

AU - Christensen, Erika Frischknecht

AU - Christiansen, Christian Fynbo

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2018/5

Y1 - 2018/5

N2 - INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with a non-shockable rhythm as presenting rhythm in out-of-hospital cardiac arrest (OHCA). Whether the severity of the underlying disease is related to presenting rhythm is unknown. We hypothesized that increased severity of COPD in OHCA patients is associated with an increased prevalence of non-shockable rhythm.METHODS: This study included OHCA patients ≥40 years from the Danish Cardiac Arrest Registry (2001-2014). Population-based registries were used to identify chronic diseases and drug prescriptions. COPD was defined as a COPD diagnosis or pharmacological therapy for COPD. The severity of COPD was based on either 1) pharmacological therapy (mild/moderate/severe), 2) admission for exacerbation, 3) prescription for corticosteroids, or 4) forced expiratory volume in 1 s (FEV1). For each of these, a multivariable logistic regression model was used to estimate odds ratios (ORs) for a non-shockable rhythm.RESULTS: Of 33,228 patients with OHCA 7789 (23.4%) had COPD. Of these 6702 (86.0%) had a non-shockable rhythm. Compared to patients without COPD, mild COPD was associated with a non-shockable rhythm (OR = 1.46, 95%CI 1.29-1.65). This association was more pronounced for moderate (OR = 1.78, 95%CI 1.45-2.19) and severe COPD (OR = 2.01 95%CI 1.82-2.20). Recent admission for exacerbation (OR = 2.12, OR 95%CI 1.81-2.49) or prescription for corticosteroids (OR = 1.82, 95%CI 1.55-2.14) was also associated with a non-shockable rhythm. FEV1 ≤ 50% was associated with a non-shockable rhythm compared to FEV1 > 50% (OR = 1.74, 95%CI 1.07-2.82, n = 1122).CONCLUSION: Incremental severity of COPD is associated with increasing prevalence of a non-shockable rhythm as presenting rhythm in OHCA patients.

AB - INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with a non-shockable rhythm as presenting rhythm in out-of-hospital cardiac arrest (OHCA). Whether the severity of the underlying disease is related to presenting rhythm is unknown. We hypothesized that increased severity of COPD in OHCA patients is associated with an increased prevalence of non-shockable rhythm.METHODS: This study included OHCA patients ≥40 years from the Danish Cardiac Arrest Registry (2001-2014). Population-based registries were used to identify chronic diseases and drug prescriptions. COPD was defined as a COPD diagnosis or pharmacological therapy for COPD. The severity of COPD was based on either 1) pharmacological therapy (mild/moderate/severe), 2) admission for exacerbation, 3) prescription for corticosteroids, or 4) forced expiratory volume in 1 s (FEV1). For each of these, a multivariable logistic regression model was used to estimate odds ratios (ORs) for a non-shockable rhythm.RESULTS: Of 33,228 patients with OHCA 7789 (23.4%) had COPD. Of these 6702 (86.0%) had a non-shockable rhythm. Compared to patients without COPD, mild COPD was associated with a non-shockable rhythm (OR = 1.46, 95%CI 1.29-1.65). This association was more pronounced for moderate (OR = 1.78, 95%CI 1.45-2.19) and severe COPD (OR = 2.01 95%CI 1.82-2.20). Recent admission for exacerbation (OR = 2.12, OR 95%CI 1.81-2.49) or prescription for corticosteroids (OR = 1.82, 95%CI 1.55-2.14) was also associated with a non-shockable rhythm. FEV1 ≤ 50% was associated with a non-shockable rhythm compared to FEV1 > 50% (OR = 1.74, 95%CI 1.07-2.82, n = 1122).CONCLUSION: Incremental severity of COPD is associated with increasing prevalence of a non-shockable rhythm as presenting rhythm in OHCA patients.

KW - Aged

KW - Aged, 80 and over

KW - Cardiopulmonary Resuscitation/statistics & numerical data

KW - Denmark/epidemiology

KW - Electric Countershock/statistics & numerical data

KW - Humans

KW - Middle Aged

KW - Out-of-Hospital Cardiac Arrest/etiology

KW - Pulmonary Disease, Chronic Obstructive/classification

KW - Registries

KW - Severity of Illness Index

U2 - 10.1016/j.resuscitation.2018.03.006

DO - 10.1016/j.resuscitation.2018.03.006

M3 - Journal article

C2 - 29518438

SN - 0300-9572

VL - 126

SP - 111

EP - 117

JO - Resuscitation

JF - Resuscitation

ER -