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Long term clinical outcomes in survivors after out-of-hospital cardiac arrest

Published:December 19, 2019DOI:https://doi.org/10.1016/j.ejim.2019.11.024

      Highlights

      • Data regarding clinical long-term outcomes after OHCA are scarce.
      • OHCA survivors face significant morbidity and mortality after the index event.
      • Neurological outcome, time from CA to CPR, age and LVEF were predictors of worse f/u.
      • Clinically relevant events during f/u were not always directly related with the CA.
      • Survivors may benefit from multidisciplinary teams providing integral management.

      Abstract

      Introduction and objectives

      Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events.

      Methods

      Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up.

      Results

      A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9–69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578–7.777)], non-shockable rhythm [HR 2.926 (1.390–6.163)], time to onset of CPR [HR 1.063 (0.997–1.134)], older age [1.036 (1.008–1.064)) and worse ejection fraction at discharge [1.033 (1.009–1.058)].

      Conclusions

      Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of care.

      Keywords

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