Predictors of mortality and neurological function in ICU patients recovering from cardiac arrest: A Spanish nationwide prospective cohort study
Por:
Loza, A, del Nogal, F, Macias, D, Leon, C, Socias, L, Herrera, L, Yuste, L, Ferrero, J, Vidal, B, Sanchez, J, Zabalegui, A, Saavedra, P and Lesmes, A
Publicada:
1 nov 2020
Categoría:
Critical care and intensive care medicine
Resumen:
Objective: To identify predictors of mortality and neurological function in adult ICU patients recovering from cardiac arrest.
Design: A prospective cohort multicenter study was carried out.
Setting: Forty-six polyvalent ICUs.
Patients: A total of 595 patients recovering from out-of-hospital cardiac arrest (OHCA, n = 285) or in-hospital cardiac arrest (IHCA, n = 310).
Main outcome variables: Survival and recovery of neurological function.
Results: The mean cardiopulmonary resuscitation time was 18 min (range 10-30). Moderate hypothermia was used in 197 patients, and 150 underwent percutaneous coronary intervention (PCI). Return of spontaneous circulation (ROSC) was achieved within 20 min in 370 patients. Variables associated to mortality (ICU and in-hospital) were age (odds ratio [OR] = 1.0, 95%CI 1.0-1.0 per year), non-cardiac origin of cardiac arrest (OR = 2.16, 95%CI 1.38-3.38; P = 0.001) and ROSC 20 min (OR = 3.07, 95%CI 1.97-4.78; P < 0.001), whereas PCI and the presence of shockable rhythm exhibited a protective effect. Favorable neurological outcome was associated to shockable rhythm, ROSC <20 min, and cardiac origin of arrest. Hypothermia did not affect survival or neurological outcome in the multivariate analysis.
Conclusions: Age, non-cardiac origin of cardiac arrest and ROSC 20 min were predictors of mortality. In contrast, cardiac arrest of cardiac origin, ROSC <20 min, and defibrillable rhythms were associated to unfavorable neurological outcomes. (c) 2020 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.
Filiaciones:
Loza, A:
Univ Seville, Hosp Univ Valme, Intens Care Unit, Seville, Spain
del Nogal, F:
Spanish Soc Intens Care Med & Coronary Units SEMI, Natl Cardio Pulm Resuscitat Plan PNRCP, Madrid, Spain
Macias, D:
Univ Seville, Hosp Univ Valme, Intens Care Unit, Seville, Spain
Leon, C:
Univ Seville, Hosp Univ Valme, Intens Care Unit, Seville, Spain
Socias, L:
Hosp Son Llatzer, Intens Care Unit, Palma De Mallorca, Illes Balears, Spain
Herrera, L:
Hosp Gen Univ Santa Maria del Rosell, Intens Care Unit, Murcia, Spain
Yuste, L:
Hosp Gen Univ Ciudad Real, Intens Care Unit, Ciudad Real, Spain
Ferrero, J:
Hosp Univ Fdn Alcorcon, Intens Care Unit, Madrid, Spain
:
Hosp Gen Univ Castello, Intens Care Unit, Castellon de La Plana, Spain
Sanchez, J:
Hosp Univ Rio Hortega, Intens Care Unit, Valladolid, Spain
Zabalegui, A:
Hosp Univ Burgos, Intens Care Unit, Burgos, Spain
Saavedra, P:
Univ Las Palmas Gran Canaria, Math Dept, Las Palmas Gran Canaria, Spain
Lesmes, A:
Univ Seville, Hosp Univ Valme, Intens Care Unit, Seville, Spain
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