SCAI SHOCK STAGES PREDICT HOSPITAL MORTALITY IN OUT-OF-HOSPITAL CARDIAC ARREST PATIENTS

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

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Changes in Therapeutic Hypothermia and Coronary Intervention Provision and In-hospital Mortality of Patients With Out-of-Hospital Cardiac Arrest

Survey of Anesthesiology ◽

10.1097/01.sa.0000504588.25198.e1 ◽

2016 ◽

Vol 60 (6) ◽

pp. 229-230

Author(s):

T. Tagami ◽

H. Matsui ◽

K. Fushimi ◽

H. Yasunaga

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Therapeutic Hypothermia ◽

Coronary Intervention ◽

Hospital Cardiac Arrest

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Echocardiographic left ventricular diastolic dysfunction predicts hospital mortality after out-of-hospital cardiac arrest

Journal of Critical Care ◽

10.1016/j.jcrc.2018.06.016 ◽

2018 ◽

Vol 47 ◽

pp. 114-120 ◽

Cited By ~ 8

Author(s):

Jacob C. Jentzer ◽

Nandan S. Anavekar ◽

Sunil V. Mankad ◽

Majd Khasawneh ◽

Roger D. White ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Diastolic Dysfunction ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Ventricular Diastolic Dysfunction ◽

Hospital Cardiac Arrest

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Association of Taurine with In-Hospital Mortality in Patients after Out-of-Hospital Cardiac Arrest: Results from the Prospective, Observational COMMUNICATE Study

Journal of Clinical Medicine ◽

10.3390/jcm9051405 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1405 ◽

Cited By ~ 1

Author(s):

Naemi Herzog ◽

Rahel Laager ◽

Emanuel Thommen ◽

Madlaina Widmer ◽

Alessia M. Vincent ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Neurological Outcome ◽

Cerebral Performance Category ◽

University Hospital ◽

Neurological Deficits ◽

Receiver Operating Curve ◽

Taurine Concentration ◽

Neurological Outcomes ◽

Hospital Cardiac Arrest

Background: Studies have suggested that taurine may have neuro- and cardio-protective functions, but there is little research looking at taurine levels in patients after out-of-hospital cardiac arrest (OHCA). Our aim was to evaluate the association of taurine with mortality and neurological deficits in a well-defined cohort of OHCA patients. Methods: We prospectively measured serum taurine concentration in OHCA patients upon admission to the intensive care unit (ICU) of the University Hospital Basel (Switzerland). We analyzed the association of taurine levels and in-hospital mortality (primary endpoint). We further evaluated neurological outcomes assessed by the cerebral performance category scale. We calculated logistic regression analyses and report odds ratios (OR) and 95% confidence intervals (CI). We calculated different predefined multivariable regression models including demographic variables, comorbidities, initial vital signs, initial blood markers and resuscitation measures. We assessed discrimination by means of area under the receiver operating curve (ROC). Results: Of 240 included patients, 130 (54.2%) survived until hospital discharge and 110 (45.8%) had a favorable neurological outcome. Taurine levels were significantly associated with higher in-hospital mortality (adjusted OR 4.12 (95%CI 1.22 to 13.91), p = 0.02). In addition, a significant association between taurine concentration and a poor neurological outcome was observed (adjusted OR of 3.71 (95%CI 1.13 to 12.25), p = 0.03). Area under the curve (AUC) suggested only low discrimination for both endpoints (0.57 and 0.57, respectively). Conclusion: Admission taurine levels are associated with mortality and neurological outcomes in OHCA patients and may help in the risk assessment of this vulnerable population. Further studies are needed to assess whether therapeutic modulation of taurine may improve clinical outcomes after cardiac arrest.

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The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

Critical Care ◽

10.1186/s13054-020-03039-6 ◽

2020 ◽

Vol 24 (1) ◽

Cited By ~ 1

Author(s):

Peter J. McGuigan ◽

Manu Shankar-Hari ◽

David A. Harrison ◽

John G. Laffey ◽

Danny F. McAuley

Keyword(s):

Carbon Dioxide ◽

Cardiac Arrest ◽

Cohort Study ◽

Hospital Mortality ◽

Arterial Oxygenation ◽

Hospital Cardiac Arrest

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338 Causes and hospital mortality in a large cohort of out-of-hospital cardiac arrest

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(10)70340-2 ◽

2010 ◽

Vol 2 (1) ◽

pp. 111-112 ◽

Cited By ~ 1

Author(s):

Olivier Giovannetti ◽

Florence Dumas ◽

Virginie Lemiale ◽

Muriel Tafflet ◽

Jean Philippe Empana ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Large Cohort ◽

Hospital Cardiac Arrest

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The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

The Korean Journal of Critical Care Medicine ◽

10.4266/kjccm.2012.27.4.255 ◽

2012 ◽

Vol 27 (4) ◽

pp. 255

Author(s):

Ki Tae Kim ◽

Byung Kook Lee ◽

Hyoung Youn Lee ◽

Geo Sung Lee ◽

Yong Hun Jung ◽

...

Keyword(s):

Cardiac Arrest ◽

Blood Glucose ◽

Hospital Mortality ◽

Therapeutic Hypothermia ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Hospital Cardiac Arrest

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In-hospital Death Following Successful OHCA Resuscitation: Causes of early and late mortality and the impact of withdrawal of care

10.1101/2020.03.15.20029207 ◽

2020 ◽

Author(s):

Shu Li ◽

Christos Lazaridis ◽

Fernando D. Goldenberg ◽

Atman P. Shah ◽

Katie Tataris ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Human Study ◽

Early Death ◽

Organ Injury ◽

Neurological Injury ◽

Hospital Death ◽

Categorization System ◽

The Impact ◽

Hospital Cardiac Arrest

AbstractObjectiveIn-hospital mortality in patients successfully resuscitated following out-of-hospital cardiac arrest (OHCA) is high. The factors and timings of these deaths is not well known. To better understand in hospital post-OHCA mortality we developed a novel categorization system of in hospital death and studied the factors and timings associated with these deaths.MethodsThis was a single-centered retrospective observational human study in adult non-traumatic OHCA patients in a university affiliated hospital. Through an expert consensus process, a novel classification system of hospital death was developed.ResultsTwo hundred and forty-one patients were enrolled in the study. Death was categorized as due to withdrawal of life sustaining treatment (WOLST) 159 (66.0%), recurrent in-hospital cardiac arrest 51 (21.1%), or due to neurological criteria 31 (12.9%). Subcategorization of factors associated with WOLST into 7 categories was done by defined criteria. Inter-reliability of this system was 0.858. 50% of WOLST decisions were due to neurological injury. Early death (≤ 3 days) was associated with recurrent in-hospital cardiac arrest and WOLST in the setting of refractory shock or multi-organ injury. Late in-hospital death (> 3 days) was primarily due to WOLST decisions in the setting of isolated neurological injury.ConclusionsOHCA in hospital mortality occurred in a bimodal pattern with early deaths due to recurrent arrest and multiorgan injury while late deaths were due to isolated neurological injury. The majority of deaths occurred in the setting of WOLST decisions. Further study of the influence of these factors on post OHCA survival are needed.

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A Comparison of the Performance of Out-of-hospital Cardiac Arrest Score and Standard Severity Scores in Predicting Hospital Mortality and Neurological Consequence in Out-of-hospital Cardiac Arrest Patients

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2021821 ◽

2021 ◽

Author(s):

Natthaka Sathaporn ◽

Bodin Khwannimit

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Apache Ii ◽

Secondary Outcome ◽

Saps 3 ◽

Saps Ii ◽

Severity Scores ◽

Overall Performance ◽

Hospital Cardiac Arrest ◽

Better Than

Objective: There is limited data to determine the performance of general and specific severity score in out-of-hospital cardiac arrest (OHCA) patients. Hence, we compared the performance of the OHCA score with Acute Physiology and Chronic Health Evaluation (APACHE) and Simplified Acute Physiology Score (SAPS) to predict outcome in OHCA patients.Material and Methods: A retrospective study was conducted in a mixed intensive care unit of a tertiary hospital. The primary outcome was in-hospital mortality. The secondary outcome was poor neurological outcome.Results: A total of 190 OHCA patients were enrolled. The OHCA score had moderate discrimination with an area under the receiver operating characteristic curve (AUC) 0.77 (95% CI 0.7-0.837) whereas discrimination of APACHE II-IV, SAPS II, and SAPS 3 were good with an AUC more than 0.8. The actual hospital mortality rate was 64.7%. The OHCA score predicted hospital mortality of 95.3±8.4, which significantly overestimated the mortality with standardized mortality ratio 0.68 (95% CI 0.56-0.81). However, all severity scores revealed poor calibration. Additionally, overall performance of APACHE II-IV, SAPS II and SAPS 3 were better than the OHCA score. For secondary outcome, discrimination of the OHCA score was moderate with an AUC 0.790 (95% CI 0.700-0.878) whereas other severity scores demonstrated good discrimination with AUC more than 0.8.Conclusion: APACHE II-IV, SAPS II, and SAPS 3 indicated superior overall performance and demonstrated good discrimination for predicting hospital mortality and unfavorable neurological consequence better than the OHCA score. However, all severity scores attested poor calibration, therefore, specific scores for OHCA patients should be modified.

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