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Resuscitation. 2014 Oct;85(10):1364-9. doi: 10.1016/j.resuscitation.2014.06.028. Epub 2014 Jul 8.

Impact of intensified postresuscitation treatment on outcome of comatose survivors of out-of-hospital cardiac arrest according to initial rhythm.

Author information

1
Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia.
2
Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia. Electronic address: marko.noc@mf.uni-lj.si.

Abstract

AIM:

We investigated the impact of intensified postresuscitation treatment in comatose survivors of out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology according to the initial rhythm at the emergency medical team arrival.

METHODS:

Interventions and survival with Cerebral Performance Category (CPC) 1-2 within each group were retrospectively compared between the periods of conservative (1995-2003) and intensified (2004-2012) postresuscitation treatment.

RESULTS:

In shockable group, therapeutic hypothermia (TH) increased from 1 to 93%, immediate invasive coronary strategy from 28 to 78%, intraaortic balloon pump from 4 to 21%, vasopressors/inotropes from 47 to 81% and antimicrobial agents from 65 to 86% during the intensified period as compared to conservative period (p<0.001). This was associated with increased survival with CPC 1-2 from 27 to 47% (p<0.001). After adjusting for age, sex and prehospital confounders, TH (OR=2.12, 95% CI 1.25-3.61), percutaneous coronary intervention (OR 1.77, 95% CI 1.15-2.73) and antimicrobial agents (OR=12.21, 95% CI 5.13-29.08) remained associated with survival with CPC 1-2. In non-shockable patients, TH also significantly increased from 1 to 74%, immediate invasive coronary strategy from 8 to 51%, intraaortic balloon pump from 2 to 9% and vasopressors/inotropes from 56 to 84% during intensified period without concomitant increase in survival with CPC 1-2 (7% vs. 9%; p=0.27). After adjustment, only antimicrobial agents (OR=8.43, 95% CI: 1.05-67.72) remained associated with survival with CPC 1-2.

CONCLUSION:

Intensified postresuscitation treatment was associated with doubled survival in comatose survivors of OHCA with shockable rhythm. Such association could not be demonstrated in patients with non-shockable rhythm.

KEYWORDS:

Cardiac arrest; Cerebral performance category; Comatose survivors; Hypothermia; Percutaneous coronary intervention; Postresuscitation care

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