Abstract 01: The Importance of Time to Cooling in Out-Of-Hospital Cardiac Arrest Patients to Influence Neurologically Intact Survival: A Sub-Analysis of the Princess Trial

Background: Early initiation of hypothermia has shown to be important to reduce brain injuries in experimental cardiac arrest models. The aim of this study was to investigate the association between time to initiate cooling and neurological intact survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: A secondary analysis of prospectively collected data from the PRINCESS trial (NCT01400373) including 677 OHCA patients randomized to transnasal evaporative intra-arrest cooling or standard advanced life support and cooling started subsequent to hospital arrival. Time to randomization was used a proxy measurement for time to initiate cooling. An early treatment group was defined as patients randomized by the EMS <20 minutes from the time of the cardiac arrest. Propensity scores were used to find matching patients in the control group. Patients with initial shockable rhythms were analyzed as a predefined subgroup. The primary outcome was good neurologic outcome, Cerebral Performance Category (CPC) 1-2 at 90 days. Secondary outcome was complete recovery (CPC 1). Results: In total 406 patients were randomized <20 minutes from the cardiac arrest and were propensity score matched (1:1). In the propensity score matched analysis the proportion of patients with CPC 1-2 was 21.7% in the intervention and 17.2% in the control group, odds ratio (OR) 1.33, 95% confidence interval (CI) 0.80-2.21, p=0.273. In patients with initial shockable rhythm (79 intervention, 79 control) the difference in CPC 1-2 was 48.1% versus 32.0%, OR 2.05, 95%CI 1.00-4.21, p=0.0498. The proportion of patients with complete neurologic recovery, CPC 1, was 19.7% in the intervention and 13.3% in the control group, OR 1.60, 95% CI 0.92-2.79, p=0.097. In patients with initial shockable rhythm the proportion with CPC 1 was 45.6% versus 24.6%, OR 2.81, 95% CI 1.23-6.42, p=0.014. Conclusions: In this ancillary study of OHCA patients receiving intra-arrest cooling, there were differences in survival with good neurologic outcome and in complete neurological recovery in favor of early intra-arrest cooling patient group compared to standard care. These differences were statistically significant in the subgroup of patients with initial shockable rhythms.

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How many prehospital defibrillation attempts should be performed in out-of-hospital cardiac arrest patients with shockable rhythm?

10.21203/rs.3.rs-106512/v1 ◽

2020 ◽

Author(s):

Byuk Sung Ko ◽

Youn-Jung Kim ◽

Kap Su Han ◽

You Hwan Jo ◽

Jonghwan Shin ◽

...

Keyword(s):

Cardiac Arrest ◽

Odds Ratio ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Neurologic Outcome ◽

Secondary Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Shockable Rhythm ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

Abstract Background: Early defibrillation is vital to improve outcomes after out-of-hospital cardiac arrest (OHCA) with shockable rhythm. Currently, there is no agreed consensus on the number of defibrillation attempts before transfer to a hospital. This study aimed to evaluate the correlation between the number of defibrillations on the prehospital return of spontaneous circulation (ROSC).Methods: A multicenter, prospective, observational registry-based study was conducted for OHCA in patients with presumed cardiac etiology that underwent prehospital defibrillation between October 2015 and June 2017. The primary outcome was prehospital ROSC, and the secondary outcome was a good neurologic outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Results: Among 2,155 OHCA patients’ data, 178 patients with missing data were excluded, a total of 1,983 OHCA patients who received prehospital defibrillation were included. The median age was 61 years and prehospital ROSC was observed in 738 patients (37.2%). The median time from arrest to first defibrillation was 10 (interquartile range: 7-15) minutes. The cumulative ROSC rates and good neurologic outcome from the initial defibrillation to the sixth defibrillation were 43%, 68%, 81%, 90%, 95%, 98% and 42%, 66%, 81%, 90%, 95%, 98%, respectively. After clinical characteristics adjustment and time to defibrillation, the number of defibrillations were independently associated with ROSC (odds ratio 0.81 95% CI 0.76-0.86) and good neurologic outcome (odds ratio 0.86 95% CI 0.80-0.91). Moreover, subgroup analysis results with patients that underwent the initial defibrillation within 10 minutes from arrest were consistent (95% up to five times).Conclusion: More than 95% of prehospital ROSC was achieved within five times of defibrillation in OHCA patients. This result provides a basis for the ideal number of defibrillation attempts before transfer to hospital with the possibility of extracorporeal cardiopulmonary resuscitation in these refractory ventricular fibrillation patients.

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Promising candidates for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Scientific Reports ◽

10.1038/s41598-020-79283-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yo Sep Shin ◽

Youn-Jung Kim ◽

Seung Mok Ryoo ◽

Chang Hwan Sohn ◽

Shin Ahn ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

Neurologic Outcome ◽

Low Flow ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurologic Status ◽

Good Neurologic Outcome ◽

Hospital Stays ◽

Hospital Cardiac Arrest

AbstractPrecise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.

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Abstract 113: Signs of Perfusion During Cardiopulmonary Resuscitation as Noted by First Responders is Predictive of Good Neurologic Outcome in Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.113 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Johanna C Moore ◽

Michael Grahl ◽

Tracy Marko ◽

Ariel Blythe-Reske ◽

Amber Lage ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Life Support ◽

Cerebral Performance Category ◽

First Responders ◽

Small Sample ◽

Neurologic Outcome ◽

Discharge Data ◽

Good Neurologic Outcome ◽

Neurologically Intact

Background: Rates of neurologically intact survival after cardiac arrest remain abysmal. Neuro-prognostication intra-arrest is challenging, with few real-time factors that can be used to determine patient prognosis. During the implementation of a new cardiopulmonary resuscitation (CPR) protocol in a large urban pre-hospital system, first responders prospectively recorded the presence of signs of perfusion during CPR. Hypothesis: Positive signs of perfusion would be a predictor of a good neurologic outcome in this observational study, as defined by Cerebral Performance Category (CPC) Score of 1 or 2. Methods: Basic life support first responders (n = 420) and paramedics (n = 207) underwent training including didactic and hands-on sessions to learn the new protocol, which included active compression-decompression CPR with an impedance threshold device. In addition to patient demographics and circumstances of cardiac arrest, signs of perfusion during CPR were prospectively recorded and included improved color, pulse during CPR, gasping, and movement during CPR. Chart review was performed to determine CPC score at discharge. Data were analyzed using descriptive statistics and calculation of unadjusted odds ratios. Results: The new protocol began May 1, 2017. Cases from May 2017-November 2017 (n= 102) were reviewed, with complete data available for 96 patients (94%). The median age was 56 (range 25-97), 54/91 (59%) male, 43/102 (42%) witnessed, 31/90 (34%) shockable rhythm, and 51/102 (50%) receiving bystander CPR. Improved color during CPR was seen in 23/102 (23%), pulse during CPR in 17/102 (17%), gasping in 18/102 (18%), and movement during CPR in 5/102 (5%). Any sign of perfusion during CPR was seen in 47/102 (46%), and 13/96 (13.5%) had a CPC score of 1 or 2 at discharge. The unadjusted OR for any sign of perfusion during CPR for a CPC score of 1 or 2 was 26 (95% CI 3 - 213) and for any sign of perfusion during CPR for ROSC was 9 (95% CI 3 - 24). Conclusions: Positive signs of perfusion during CPR noted by first responders strongly predicted ROSC and neurologically intact survival in this small sample. This suggests the importance of prospectively recording signs of perfusion during resuscitation, and communicating these observations during transfer of care.

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Abstract 29: Comparison of Amiodarone versus Lidocaine for Treatment of In-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.29 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Deborah S Wagner ◽

Humaira Nawer ◽

Steven L Kronick ◽

James A Cranford ◽

Steven M Bradley ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Randomized Clinical Trials ◽

Life Support ◽

Cerebral Performance Category ◽

Heart Association ◽

The United States ◽

Neurologic Outcome ◽

Multivariable Logistic Regression Analysis ◽

Hospital Cardiac Arrest

Introduction: Over 200,000 patients are treated annually in the United States for in-hospital cardiac arrest (IHCA). Patients with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) have a survival rate of less than 50%. The current American Heart Association (AHA) Advanced Cardiovascular Life Support guidelines suggest amiodarone or lidocaine as first-line agents for shock-refractory VF/pVT based on randomized clinical trials in adults with out-of-hospital cardiac arrest. Based on these results, we hypothesized that amiodarone and lidocaine have equivalent efficacy in treating hospitalized patients with VF/pVT. Methods: This is a retrospective risk-adjusted cohort study using the AHA Get with the Guidelines-Resuscitation® (GWTG-R) registry. The study included adult patients between January 1, 2000 to December 31, 2014 with IHCA due to VF/pVT that received either amiodarone or lidocaine. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were 24-hour survival, survival to hospital discharge, and survival with favorable neurologic outcome based on Cerebral Performance Category (CPC) 1 or 2. Results: A total of 14,630 events were included in the analysis. Among patients who met inclusion criteria, 68.7% (n=10,058) were treated with amiodarone and 31.3% (n=4,572) were treated with lidocaine. Results from multivariable logistic regression analysis showed that, controlling for 19 covariates, ROSC rates were not statistically different with lidocaine treatment vs. amiodarone (AOR = 1.02, 95% CI 0.94, 1.11). However, lidocaine treatment was associated with higher odds of a) 24-hour survival, AOR = 1.14, 95% CI 1.06, 1.23; b) survival to discharge, AOR = 1.15, 95% CI 1.06, 1.24; and c) favorable neurologic outcome at hospital discharge, AOR = 1.21, 95% CI 1.11, 1.31. Conclusion: In adult IHCA patients with VF/pVT, treatment with lidocaine compared to amiodarone was not associated with higher ROSC rates, but was associated with higher rates of survival and favorable neurological outcomes. Additional research is needed to determine the optimal antiarrhythmic therapy for VF/pVT in IHCA.

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Prehospital Advanced Cardiac Life Support with a Smartphone-Based Direct Medical Oversight in a Metropolitan City, Korea

10.32592/ircmj.2021.23.6.513 ◽

2021 ◽

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Propensity Score Matching ◽

Neurological Outcome ◽

Life Support ◽

Advanced Life Support ◽

Neurologic Outcome ◽

Good Neurological Outcome ◽

Metropolitan City ◽

Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is considered an important health care problem because it causes family breakdown and enormous social loss due to sudden death. Despite the efforts of many medical policymakers, paramedics, and doctors, the survival rate after cardiac arrest is only marginally increasing. Objective: This study aimed to determine whether advanced life support (ALS) under physician’s direct medical oversight during an emergency through video call on smartphones was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on the "Smart Advanced Life Support (SALS)" pilot project. Methods: This study was conducted using a "Before-After" controlled trial. The OHCA patients were divided into two periods in a metropolitan city. The basic life support (BLS group) and ALS using video calls on smartphones (SALS group) were performed in the 'Before' and 'After' phases in 2014 and 2015, respectively. The OHCA patients over 18 years of age were included in this study. On the other hand, the patients with trauma, poisoning, and family’s unwillingness, as well as those who received no resuscitation were excluded from the study. The primary and secondary outcomes were survival to discharge and a good neurological outcome (cerebral performance category [CPC] 1-2), respectively. A propensity score matching was conducted to equalize potential prognostic factors in both groups. The adjusted odds ratio (OR) and 95% confidence interval (95% CI) were calculated for survival to discharge and good neurological outcome. Results: In total, 235 and 198 OHCA patients were enrolled in the BLS and the SALS groups, respectively. The outcomes were better in the SALS group, compared to the BLS group regarding the survival to discharge (9.8% vs. 6.8%, P<0.001) and good neurological outcome (6.6% vs. 4.0%, P<0.001), respectively. Regarding propensity score matching, 304 cases were randomly assigned to the SALS and BLS groups. The survivals to discharge rates after matching were 9.2% and 7.2% in the SALS and the BLS groups, respectively (P=0.06). Furthermore, the good neurological outcome rate was 5.9% in the SALS group versus 3.9% in the BLS group (p=0.008). The adjusted ORs of the SALS group were estimated at 1.33 (95% CI: 1.00-1.77) for survival to discharge and 1.73 (95% CI: 1.19-2.53) for the good neurologic outcome, compared to those in the BLS group. Conclusion: An emergency medical system intervention using the SALS protocol was associated with a signiﬁcant increase in prehospital ROSC and improved survival and neurologic outcome after OHCA.

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Prognostic Value of the Conversion to a Shockable Rhythm in Out-of-Hospital Cardiac Arrest Patients with Initial Non-Shockable Rhythm

Journal of Clinical Medicine ◽

10.3390/jcm8050644 ◽

2019 ◽

Vol 8 (5) ◽

pp. 644 ◽

Cited By ~ 1

Author(s):

Kap Su Han ◽

Sung Woo Lee ◽

Eui Jung Lee ◽

Su Jin Kim

Keyword(s):

Cardiac Arrest ◽

Prognostic Value ◽

Primary Outcome ◽

Prognostic Significance ◽

Spontaneous Circulation ◽

Neurologic Outcome ◽

Shockable Rhythm ◽

Control And Prevention ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter “conversion”) during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. The primary outcome was good neurologic outcome at hospital discharge. Of 85,602 patients with an initial non-shockable rhythm, 17.9% experienced conversion. Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248–3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167–4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred.

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Abstract 9114: Impact of the Number of Prehospital Defibrillation Attempts on Neurologically Intact Survival in Patients With Out-of-Hospital Cardiac Arrest and Shockable Rhythm

Circulation ◽

10.1161/circ.144.suppl_2.9114 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Kazuya Tateishi ◽

Yuichi Saito ◽

Hideki Kitahara ◽

Yoshio Tahara ◽

Naohiro Yonemoto ◽

...

Keyword(s):

Cardiac Arrest ◽

Vascular Disease ◽

Cerebral Performance Category ◽

Neurologic Outcome ◽

Cerebral Vascular Disease ◽

Shockable Rhythm ◽

Early Return ◽

Neurologically Intact ◽

Hospital Cardiac Arrest ◽

Cerebral Vascular

Background: Early return of spontaneous circulation (ROSC) leads to survival with a favorable neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA). For the early ROSC, defibrillation plays a crucial role for OHCA with shockable rhythm. However, little is known about the relation between the number of prehospital defibrillation attempts or etiology of OHCA and neurologically intact survival. Methods: Using a nationwide OHCA registry database from 2005 to 2017 in Japan, a cohort of 1,527,447 patients with OHCA were retrospectively analyzed. We included the patients of witnessed OHCAs with initial shockable rhythm. The relation between early ROSC, defined as prehospital ROSC achieved with defibrillation ≤3 times without adrenaline, and a neurologically intact survival rate (cerebral performance category score of 1 or 2 at 1 month) was evaluated. We also analyzed factors related to the successful early ROSC, including etiology of OHCA. Results: A total of 75,342 patients were included. Among patients with OHCA and prehospital ROSC, neurologically intact survival rates were better in patients who achieved early ROSC than their counterpart (62% vs. 36%, p<0.001). Success in early ROSC was an independent predictor of neurologically intact survival after adjustment of multiple cofounders (Table). Multivariate analysis showed cerebral vascular disease as an etiology of OHCA was a predictor of early ROSC (odds ratio 1.15, 95% confidence interval 1.03-1.29, p=0.02), but was significantly associated with a poor neurologic outcome at 1 month (Table). Conclusions: Success in early ROSC was associated with neurologically intact survival in patients with OHCA and initial shockable rhythm. Patients with OHCA due to cerebral vascular disease were likely to be resuscitated from cardiac arrest by defibrillations but had a poor neurologic outcome.

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Abstract 10936: Gender Disparities in In-Hospital Management of Out-of-Hospital Cardiac Arrest Patients: A Propensity Score Matching Analysis

Circulation ◽

10.1161/circ.144.suppl_2.10936 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Jooyeong Kim ◽

Kim Sung Jin ◽

Sejoong Ahn ◽

Jonghak Park ◽

Juhyun Song ◽

...

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Hospital Management ◽

Gender Disparities ◽

Neurologic Outcome ◽

Female Patients ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

Background: Gender differences of outcomes of out-of-hospital cardiac arrest (OHCA) were reported in previous studies and still remains uncertainty. Furthermore, gender disparities in in-hospital management are not well studied. Hypothesis: We hypothesized there is differences in in-hospital management in OHCA patients by gender in Korea. Method: This is an observational study using Korean Cardiac Arrest Research Consortium (KoCARC) data. Adult (age over 18 years) OHCA patients from October 2015 to June 2020 were included. The main variable of interest was gender. Primary outcomes were whether in-hospital managements such as coronary angiography (CAG), percutaneous coronary intervention (PCI), target temperature management (TTM), and extracorporeal membrane oxygenation (ECMO) were performed. Secondary outcomes were clinical outcomes such as survival to admission, survival to discharge, and good neurologic outcome (cerebral performance category 1 or 2) at discharge. The propensity score matching (PSM) method was performed to minimize differences in baselines demographics and characteristics. Results: Total 8,177 OHCA patients were enrolled. After PSM, 6564 patients (female: 2782, male: 2782) were obtained. In unmatched cohort, female patients were less likely receive CAG, PCI, TTM, ECMO and less likely to survive to admit, survive to discharge, and discharge as good neurologic outcome. In PSM cohort, female patients were less likely to receive CAG, PCI than male (179 (6.4%) vs 252 (9.1%), p<0.001 and 54 (1.9%) vs 104 (8.2%), p<0.001, respectively). The proportion of TTM, ECMO, and clinical outcomes were not statistically different among gender. Conclusions: CAG, PCI were less likely to performed in female OHCA patients. Further studies are needed for gender disparities in in-hospital management of OHCA patients.

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Abstract 234: The Association Between Post--Cardiac Arrest Hemoglobin Levels and Neurological Outcome

Circulation ◽

10.1161/circ.130.suppl_2.234 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Babette R Rosselot ◽

Anne V Grossestreuer ◽

Nora L Lee ◽

Kalani Dodampahala ◽

Munish Goyal ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Cerebral Oxygenation ◽

Cerebral Performance Category ◽

Neurologic Outcome ◽

Secondary Outcome ◽

Logistic Regression Models ◽

Patient Demographics ◽

Neurologic Outcomes ◽

Good Neurologic Outcome

Background: Inadequate cerebral oxygenation is a risk factor for neurologic damage in successfully resuscitated cardiac arrest patients. One therapy to address this problem is early goal-directed hemodynamic optimization. However, the role of hemoglobin (Hgb) levels, a potential target for optimization, on outcomes in post-cardiac arrest patients is not known. Objective: To determine the association between Hgb levels in post-cardiac arrest patients and neurologic outcome (dichotomized into “good,” a Cerebral Performance Category (CPC) of 1 or 2 and “poor,” a CPC of 3, 4, or 5, at hospital discharge). The association between Hgb levels and survival to discharge was analyzed as a secondary outcome. Methods: A retrospective cohort study was conducted to compare patient demographics and Hgb levels. Hgb was analyzed as both a continuous and binary variable. To determine the association between Hgb levels and outcomes, multivariate logistic regression models controlling for gender, age, pulseless rhythm, and transfusion were used. Results: There were 598 eligible subjects from 21 hospitals in the US. Patients with ≤10 g/dL of Hgb had a higher percentage of subjects with good neurologic outcome than those with Hgb levels below 10 g/dL (41% vs. 26%; p < 0.001). Patients with good neurologic outcome had higher median Hgb levels in the first six hours after arrest than those with a poor neurologic outcome (12.6 g/dL vs. 10.5 g/dL; p < 0.001). Controlling for gender, age, pulseless rhythm, and transfusion, there was a significant relationship between Hgb levels within the first six hours after arrest and good neurologic outcome (OR: 1.21, 95% CI: 1.06 [[Unable to Display Character: –]] 1.39) and the first 24 hours after arrest and good neurologic outcome (OR: 1.14, 95% CI: 1.01 [[Unable to Display Character: –]] 1.28). There was a significant association between Hgb levels within the first six hours after arrest and survival to discharge (OR: 1.22, 95% CI: 1.07 [[Unable to Display Character: –]] 1.39) and Hgb levels within the first 24 hours after arrest and survival to discharge (OR: 1.14, 95% CI: 1.02 [[Unable to Display Character: –]] 1.28). Conclusions: Higher hemoglobin levels, particularly within the first six hours after cardiac arrest, are associated with better neurologic outcomes at hospital discharge in post-cardiac arrest patients admitted to the hospital.

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Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest

Annals of Intensive Care ◽

10.1186/s13613-019-0593-9 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Ferran Rueda ◽

Germán Cediel ◽

Cosme García-García ◽

Júlia Aranyó ◽

Marta González-Lopera ◽

...

Keyword(s):

Cardiac Arrest ◽

Tissue Injury ◽

Cerebral Performance Category ◽

Neurologic Outcome ◽

Home Setting ◽

Growth Differentiation Factor 15 ◽

Poor Outcome ◽

Differentiation Factor ◽

Hospital Cardiac Arrest ◽

Early Predictor

Abstract Background Growth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA). Methods Prospective registry study of patients in coma after an OHCA, admitted in the intensive cardiac care unit from a single university center. Serum levels of GDF-15 were measured on admission. Neurologic status was evaluated according to the cerebral performance category (CPC) scale. The relationship between GDF-15 levels and poor neurologic outcome at 6 months was analyzed. Results Among 62 patients included, 32 (51.6%) presented poor outcome (CPC 3–5). Patients with CPC 3–5 exhibited significantly higher GDF-15 levels (median, 17.1 [IQR, 11.1–20.4] ng/mL) compared to those with CPC 1–2 (7.6 [IQR, 4.1–13.1] ng/mL; p = 0.004). Multivariable logistic regression analyses showed that age (OR, 1.09; 95% CI 1.01–1.17; p = 0.020), home setting arrest (OR, 8.07; 95% CI 1.61–40.42; p = 0.011), no bystander cardiopulmonary resuscitation (OR, 7.91; 95% CI 1.84–34.01; p = 0.005), and GDF-15 levels (OR, 3.74; 95% CI 1.32–10.60; p = 0.013) were independent predictors of poor outcome. The addition of GDF-15 in a dichotomous manner (≥ 10.8 vs. < 10.8 ng/mL) to the resulting clinical model improved discrimination; it increased the area under the curve from 0.867 to 0.917, and the associated continuous net reclassification improvement was 0.90 (95% CI 0.48–1.44), which allowed reclassification of 37.1% of patients. Conclusions After an OHCA, increased GDF-15 levels were an independent, early predictor of poor neurologic outcome. Furthermore, when added to the most common clinical factors, GDF-15 improved discrimination and allowed patient reclassification.

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