Clinicopathological correlates of out‐of‐hospital cardiac arrests

Autor: Tony Li, Jonathan Yap, Wei Qiang Chng, Julian Cheong Kiat Tay, Nur Shahidah, Colin Yeo, Han Nee Gan, Khim Leng Tong, Yih Yng Ng, Jia Hao Wu, Marian Wang, Marcus Eng Hock Ong, Chi Keong Ching
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Journal of Arrhythmia, Vol 38, Iss 3, Pp 416-424 (2022)
Druh dokumentu: article
ISSN: 1883-2148
1880-4276
DOI: 10.1002/joa3.12705
Popis: Abstract Background Sudden cardiac arrest with or without sudden cardiac death (SCD) represents a heterogeneous spectrum of underlying etiology but is often a catastrophic event. Despite improvements in pre‐hospital response and post‐resuscitation care, outcomes remain grim. Thus, we aim to evaluate the predictors of survival in out‐of‐hospital cardiac arrests (OHCAs) and describe autopsy findings of those with the uncertain cause of death (COD). Methods This is a subgroup analysis of the Singapore cohort from the Pan Asian Resuscitation Outcome Study which studied 933 OHCAs admitted to two Singapore tertiary hospitals from April 2010 to May 2012. Results Of the patients analysed, 30.2% (n = 282) had an initial return of spontaneous circulation (ROSC) at the emergency department, 18.0% (n = 168) had sustained ROSC with subsequent admission and 3.4% (n = 32) had survival to discharge. On multivariate analysis, an initial shockable rhythm, a witnessed event, prehospital defibrillation, and shorter time to hospital predicted ROSC as well as survival to discharge. A total of 163 (17.5%) autopsies were performed of which a cardiac etiology of SCD was noted in 92.1% (n = 151). Ischemic heart disease accounted for 54.3% (n = 89) of the autopsy cohort, with acute myocardial infarction (26.9%, n = 44) and myocarditis (3.7%, n = 6) rounding out the top three causes of demise. Conclusion OHCA remains a clinical presentation that portends a poor prognosis. Of those with uncertain COD, cardiac etiology appears to predominate from autopsy study. Identification of prognostic factors will play an important role in improving individual‐level and systemic‐level variables to further optimize outcomes.
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