Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support
Aim: The aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). Methods: This was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, be...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Resuscitation Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520422000303 |
| _version_ | 1811333769799401472 |
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| author | Sivagowry Rasalingam Mørk Morten Thingemann Bøtker Steffen Christensen Mariann Tang Christian Juhl Terkelsen |
| author_facet | Sivagowry Rasalingam Mørk Morten Thingemann Bøtker Steffen Christensen Mariann Tang Christian Juhl Terkelsen |
| author_sort | Sivagowry Rasalingam Mørk |
| collection | DOAJ |
| description | Aim: The aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). Methods: This was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, between January 2015 and December 2019. Kaplan-Meier estimates were used to evaluate 30-day and 30–180-day survival. Cox regression analysis was used to assess the association between covariates and one-year mortality. Results: Among 1,015 patients admitted, 698 achieved return of spontaneous circulation (ROSC) before admission, 101 patients with refractory OHCA received mechanical circulatory support (MCS) and the remaining 216 patients with refractory OHCA did not receive MCS treatment. Survival to hospital discharge was 47% (478/1015). Good neurological outcome defined as Cerebral Performance Categories 1–2 were seen among 92% (438/478) of the patients discharged from hospital. Median low-flow was 15 [8–22] minutes in the ROSC group and 105 [94–123] minutes in the MCS group. Mortality rates were high within the first 30 days, however; 30–180-day survival in patients discharged remained constant over time in both patients with ROSC on admission and patients admitted with MCS. Advanced age > 70 years (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.11–3.49), pulseless electrical activity (HR 2.39, 95% CI 1.25–4.60) and asystole HR 2.70, 95% CI 1.25–5.95) as initial rhythms were associated with one-year mortality in patients with ROSC. Conclusions: Short-term survival rates were high among patients with ROSC and patients receiving MCS. Among patients who survived to day 30, landmark analyses showed comparable 180-day survival in the two groups despite long low-flow times in the MCS group. Advanced age and initial non-shockable rhythms were independent predictors of one-year mortality in patients with ROSC on admission. |
| first_indexed | 2024-04-13T16:57:54Z |
| format | Article |
| id | doaj.art-913ee01c48d046a69d68d2b3ec866229 |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2024-04-13T16:57:54Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-913ee01c48d046a69d68d2b3ec8662292022-12-22T02:38:46ZengElsevierResuscitation Plus2666-52042022-06-0110100230Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory supportSivagowry Rasalingam Mørk0Morten Thingemann Bøtker1Steffen Christensen2Mariann Tang3Christian Juhl Terkelsen4Department of Cardiology, Aarhus University Hospital, Denmark; Aarhus University, Aarhus, Denmark; Corresponding author at: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark; Aarhus University, Aarhus, DenmarkDepartment of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark; Aarhus University, Aarhus, DenmarkDepartment of Thoracic and Vascular Surgery, Aarhus University Hospital, Denmark; Aarhus University, Aarhus, DenmarkDepartment of Cardiology, Aarhus University Hospital, Denmark; Aarhus University, Aarhus, Denmark; The Danish Heart Foundation, DenmarkAim: The aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). Methods: This was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, between January 2015 and December 2019. Kaplan-Meier estimates were used to evaluate 30-day and 30–180-day survival. Cox regression analysis was used to assess the association between covariates and one-year mortality. Results: Among 1,015 patients admitted, 698 achieved return of spontaneous circulation (ROSC) before admission, 101 patients with refractory OHCA received mechanical circulatory support (MCS) and the remaining 216 patients with refractory OHCA did not receive MCS treatment. Survival to hospital discharge was 47% (478/1015). Good neurological outcome defined as Cerebral Performance Categories 1–2 were seen among 92% (438/478) of the patients discharged from hospital. Median low-flow was 15 [8–22] minutes in the ROSC group and 105 [94–123] minutes in the MCS group. Mortality rates were high within the first 30 days, however; 30–180-day survival in patients discharged remained constant over time in both patients with ROSC on admission and patients admitted with MCS. Advanced age > 70 years (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.11–3.49), pulseless electrical activity (HR 2.39, 95% CI 1.25–4.60) and asystole HR 2.70, 95% CI 1.25–5.95) as initial rhythms were associated with one-year mortality in patients with ROSC. Conclusions: Short-term survival rates were high among patients with ROSC and patients receiving MCS. Among patients who survived to day 30, landmark analyses showed comparable 180-day survival in the two groups despite long low-flow times in the MCS group. Advanced age and initial non-shockable rhythms were independent predictors of one-year mortality in patients with ROSC on admission.http://www.sciencedirect.com/science/article/pii/S2666520422000303Mechanical circulatory supportOut-of-hospital cardiac arrestExtracorporeal cardiopulmonary resuscitationNeurological outcomeImpella |
| spellingShingle | Sivagowry Rasalingam Mørk Morten Thingemann Bøtker Steffen Christensen Mariann Tang Christian Juhl Terkelsen Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support Resuscitation Plus Mechanical circulatory support Out-of-hospital cardiac arrest Extracorporeal cardiopulmonary resuscitation Neurological outcome Impella |
| title | Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support |
| title_full | Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support |
| title_fullStr | Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support |
| title_full_unstemmed | Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support |
| title_short | Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support |
| title_sort | survival and neurological outcome after out of hospital cardiac arrest treated with and without mechanical circulatory support |
| topic | Mechanical circulatory support Out-of-hospital cardiac arrest Extracorporeal cardiopulmonary resuscitation Neurological outcome Impella |
| url | http://www.sciencedirect.com/science/article/pii/S2666520422000303 |
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