Out of hospital cardiac arrest - new insights and a call for a worldwide registry and guidelines.
Acute coronary syndrome
Cardiac arrest
Cardiac intensive care unit
Outcomes
Journal
BMC emergency medicine
ISSN: 1471-227X
Titre abrégé: BMC Emerg Med
Pays: England
ID NLM: 100968543
Informations de publication
Date de publication:
02 Aug 2024
02 Aug 2024
Historique:
received:
20
01
2024
accepted:
24
07
2024
medline:
3
8
2024
pubmed:
3
8
2024
entrez:
2
8
2024
Statut:
epublish
Résumé
Out of hospital cardiac arrest (OHCA) is a major public health problem with substantial mortality rates worldwide. Genetic diseases and primary electrical disorders are the most common etiologies at younger ages, while ischemic heart disease and cardiomyopathies are common causes at older ages. Despite improvement in prevention and treatment in recent years, OHCA is still a major cause of cardiovascular death. We report prospective data regarding etiology, characteristics, clinical course, and outcomes of patients with OHCA who were admitted to a tertiary care center intensive cardiac care unit (ICCU) between 2020-2023. A total of 92 patients admitted after OHCA were included in the cohort. Mean age was 63.8 ± 13.8 years and 75 (82%) were males. The most common etiology of OHCA was acute coronary syndrome (ACS) in 54 (59%) patients, of whom 46 (85%) patients had ST elevation myocardial infarction and 8 (15%) had non-ST elevation myocardial infarction. During hospitalization, 42 (46%) patients underwent targeted temperature management and 13 (14%) received mechanical circulatory support. Interestingly, 77 (84%) patients underwent coronary angiography, while only 51 (55%) received percutaneous coronary intervention (PCI). Neurologic status was favorable in 49 (53%) patients with Cerebral Performance Category score of 1-2. Overall, mortality rates were relatively low, with 15 (16%) in-hospital deaths and 24 (26%) deaths at 30-day follow-up. Although ACS was the most common etiology for OHCA, only 55% of patients underwent PCI. Most OHCA patients admitted to the ICCU survived hospitalization and were discharged. Increased awareness, public education, worldwide registries, and specific evidence-based guidelines for the treatment of OHCA patients may lead to improved outcomes for these patients who often carry poor prognoses.
Identifiants
pubmed: 39095722
doi: 10.1186/s12873-024-01060-4
pii: 10.1186/s12873-024-01060-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
140Informations de copyright
© 2024. The Author(s).
Références
Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24(1):61.
doi: 10.1186/s13054-020-2773-2
pubmed: 32087741
pmcid: 7036236
Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, et al. 2023 American Heart Association focused update on adult advanced cardiovascular life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024;149(5):e254.
doi: 10.1161/CIR.0000000000001194
pubmed: 38108133
McCarthy JJ, Carr B, Sasson C, Bobrow BJ, Callaway CW, Neumar RW, et al. Out-of-hospital cardiac arrest resuscitation systems of care: a scientific statement from the American Heart Association. Circulation. 2018;137(21):e645.
doi: 10.1161/CIR.0000000000000557
pubmed: 29483084
Kong MH, Fonarow GC, Peterson ED, Curtis AB, Hernandez AF, Sanders GD, et al. Systematic review of the incidence of sudden cardiac death in the United States. J Am Coll Cardiol. 2011;57(7):794–801.
doi: 10.1016/j.jacc.2010.09.064
pubmed: 21310315
pmcid: 3612019
Gräsner JT, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I, et al. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study. Resuscitation. 2020;148:218–26.
doi: 10.1016/j.resuscitation.2019.12.042
pubmed: 32027980
Batt A, Lanos C, Delport S, Al-Hasan D, Knox S, Alhmoudi A, et al. Out-of-hospital cardiac arrest in countries of the Gulf Cooperation Council: a scoping review. East Mediterr Health J. 2021;27(7):707–17.
doi: 10.26719/emhj.20.141
pubmed: 34369586
Irfan FB, Castren M, Bhutta ZA, George P, Qureshi I, Thomas SH, et al. Ethnic differences in out-of-hospital cardiac arrest among Middle Eastern Arabs and North African populations living in Qatar. Ethn Health. 2021;26(3):460–9.
doi: 10.1080/13557858.2018.1530736
pubmed: 30303400
Khazaal F, Arabi A, Patel A, Singh R, al Suwaidi JM, Al-Qahtani A, et al. Gender association with incidence, clinical profile, and outcome of out-of-hospital cardiac arrest: a Middle East perspective. Heart Views. 2022;23(2):67–72.
doi: 10.4103/heartviews.heartviews_73_21
pubmed: 36213432
pmcid: 9542974
Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest. Circulation. 2015;132(13):1286–300.
doi: 10.1161/CIR.0000000000000144
pubmed: 25391522
Chen N, Callaway CW, Guyette FX, Rittenberger JC, Doshi AA, Dezfulian C, et al. Arrest etiology among patients resuscitated from cardiac arrest. Resuscitation. 2018;130:33–40.
doi: 10.1016/j.resuscitation.2018.06.024
pubmed: 29940296
pmcid: 6092216
Desch S, Freund A, Akin I, Behnes M, Preusch MR, Zelniker TA, et al. Angiography after out-of-hospital cardiac arrest without ST-segment elevation. N Engl J Med. 2021;385(27):2544–53.
doi: 10.1056/NEJMoa2101909
pubmed: 34459570
Lemkes JS, Janssens GN, van der Hoeven NW, Jewbali LSD, Dubois EA, Meuwissen M, et al. Coronary angiography after cardiac arrest without ST-segment elevation. N Engl J Med. 2019;380(15):1397–407.
doi: 10.1056/NEJMoa1816897
pubmed: 30883057
Heyne S, Macherey S, Meertens MM, Braumann S, Nießen FS, Tichelbäcker T, et al. Coronary angiography after cardiac arrest without ST-elevation myocardial infarction: a network meta-analysis. Eur Heart J. 2022;44(12):1040–54.
Ameloot K, de Deyne C, Eertmans W, Ferdinande B, Dupont M, Palmers PJ, et al. Early goal-directed haemodynamic optimization of cerebral oxygenation in comatose survivors after cardiac arrest: the neuroprotect post-cardiac arrest trial. Eur Heart J. 2019;40(22):1804–14.
doi: 10.1093/eurheartj/ehz120
pubmed: 30895296
Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384(24):2283–94.
doi: 10.1056/NEJMoa2100591
pubmed: 34133859
Tabi M, Burstein BJ, Ahmed A, Dezfulian C, Kashani KB, Jentzer JC. Shock severity and hospital mortality in out of hospital cardiac arrest patients treated with targeted temperature management. Shock. 2021;55(1):48–54.
doi: 10.1097/SHK.0000000000001600
pubmed: 32769819
Kilgannon JH, Roberts BW, Reihl LR, Chansky ME, Jones AE, Dellinger RP, et al. Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality. Resuscitation. 2008;79(3):410–6.
doi: 10.1016/j.resuscitation.2008.07.019
pubmed: 18990478
pmcid: 2746417
Holmström L, Juntunen S, Vähätalo J, Pakanen L, Kaikkonen K, Haukilahti A, et al. Plaque histology and myocardial disease in sudden coronary death: the Fingesture study. Eur Heart J. 2022;43(47):4923–30.
doi: 10.1093/eurheartj/ehac533
pubmed: 36172703
pmcid: 9748531
Spirito A, Vaisnora L, Papadis A, Iacovelli F, Sardu C, Selberg A, et al. Acute coronary occlusion in patients with non-ST-segment elevation out-of-hospital cardiac arrest. J Am Coll Cardiol. 2023;81(5):446–56.
doi: 10.1016/j.jacc.2022.10.039
pubmed: 36725173
Patterson T, Perkins GD, Perkins A, Clayton T, Evans R, Dodd M, et al. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet. 2023;402(10410):1329–37.
Elfassy MD, Randhawa VK, Allan KS, Dorian P. Understanding Etiologies of Cardiac Arrest: Seeking Definitional Clarity. Can J Cardiol. 2022;38(11):1715–8.