JOURNAL ARTICLE

Post-resuscitation care and outcomes of out-of-hospital cardiac arrest: a nationwide propensity score-matching analysis

Joo Yeong Kim, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Eui Jung Lee, Chang Bae Park, Seung Sik Hwang
Resuscitation 2013, 84 (8): 1068-77
23454438

OBJECTIVE: This study aimed to determine whether active post-resuscitation care (APRC) was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on a nationwide level.

METHODS AND RESULTS: We used a national OHCA cohort database consisting of hospital and ambulance data. We included all survivors of OHCA, excluding patients with non-cardiac etiology, younger than 15 years, and with unknown outcomes, from (2008 to 2010). The APRC was defined when the OHCA patients received mild therapeutic hypothermia (MTH) or active cardiac care (ACC), such as intravenous thrombolysis, percutaneous coronary intervention, coronary artery bypass surgery, and pacemaker/implantable cardioverter defibrillator insertion, as well as routine intensive care; patients receiving conservative post-resuscitation care (CPRC) served as the other group. The primary and secondary outcomes were survival to discharge and a good neurological outcome (cerebral performance category [CPC] 1-2), respectively. We extracted propensity-matched samples to control for selection bias. A multivariable logistic regression analysis was used to compare the APRC and CPRC groups adjusting for potential risks to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Of total 64,155 patients, 4557 survived to admission and were included in the final analysis. Out of these patients, 1599 (35.1%) cases survived to discharge, and 499 (11.0%) cases were discharged with good neurological recoveries. Overall, 695 cases (15.3%) received any APRC, including MTH (n=377, 8.3%) and ACC (370, 8.1%). The outcomes was better in the APRC group than in the CPRC group for survival to discharge (58.7% vs. 30.8%, p<0.001) and good neurological outcome (27.2% vs. 8.0%, p<0.001), respectively. In the total cohort, the adjusted ORs of the APRC group compared to those the CPRC group were 2.15 (95% CI 1.78-2.59) for survival to discharge and 2.54 (95% CI 1.98-3.27) for a good neurological outcome. In the propensity score-matched cohort, the adjusted ORs for survival to discharge and good neurological outcome of APRC were significantly favorable.

CONCLUSIONS: Active post-resuscitation care resulted in significantly improved outcomes in adult OHCA patients with a presumed cardiac etiology in a nationwide, retrospective, observational study.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
23454438
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"