Reduced in-hospital survival rates of out-of-hospital cardiac arrest victims with obstructive pulmonary disease

RESUSCITATION

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Article

Blom, M. T.¹  Warnier, M. J.^2,3  Bardai, A.^1,4  Berdowski, J.¹  Koster, R. W.¹  Souverein, P. C.³  Hoes, A. W.²  Rutten, F. H.²  de Boer, A.³  De Bruin, M. L.^2,3,5  Tan, H. L.¹ 

[1] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, NL-1100 DD Amsterdam, Netherlands

[2] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands

[3] Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, NL-3508 TB Utrecht, Netherlands

[4] Interuniv Cardiol Inst Netherlands, Utrecht, Netherlands

[5] Med Evaluat Board CBG MEB, NL-3503 RG Utrecht, Netherlands

关键词: Out-of-hospital cardiac arrest;    Resuscitation;    Survival;    Obstructive pulmonary disease;   

DOI  :  10.1016/j.resuscitation.2012.10.009

来源: Elsevier

【 摘 要 】

Aim: Out-of-hospital cardiac arrest (OHCA) due to sustained ventricular tachycardia/fibrillation (VT/VF) is common and often lethal. Patient's co-morbidities may determine survival after OHCA, and be instrumental in post-resuscitation care, but are poorly studied. We aimed to study whether patients with obstructive pulmonary disease (OPD) have a lower survival rate after OHCA than non-OPD patients. Methods: We performed a community-based cohort study of 1172 patients with non-traumatic OHCA with ECG-documented VT/VF between 2005 and 2008. We compared survival to Emergency Room (ER), to hospital admission, to hospital discharge, and at 30 days after OHCA, of OPD-patients and non-OPD patients, using logistic regression analysis. We also compared 30-day survival of patients who were admitted to hospital, using multivariate logistic regression analysis. Results: OPD patients (n = 178) and non-OPD patients (n = 994) had comparable survival to ER (75% vs. 78%, OR 0.9 [95% CI: 0.6-1.3]) and to hospital admission (56% vs. 57%, OR 1.0 [0.7-1.4]). However, survival to hospital discharge was significantly lower among OPD patients (21% vs. 33%, OR 0.6 [0.4-0.9]). Multivariate regression analysis among patients who were admitted to hospital (OPD: n = 100, no OPD: n = 561) revealed that OPD was an independent determinant of reduced 30-day survival rate (39% vs. 59%, adjusted OR 0.6 [0.4-1.0, p = 0.035]). Conclusion: OPD-patients had lower survival rates after OHCA than non-OPD patients. Survival to ER and to hospital admission was not different between both groups. However, among OHCA victims who survived to hospital admission, OPD was an independent determinant of reduced 30-day survival rate. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

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