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Admission predictors of in-hospital mortality and subsequent long-term outcome in survivors of ventricular fibrillation out-of-hospital cardiac arrest: a population-based study.
- Source :
-
Cardiology [Cardiology] 2004; Vol. 102 (1), pp. 41-7. Date of Electronic Publication: 2004 Feb 26. - Publication Year :
- 2004
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Abstract
- Background: Survival following out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation (VF) is poor and dependent on a rapid emergency response system. Improvements in emergent early response have resulted in a higher percentage of patients surviving to admission. However, the admission variables that predict both short- and long-term survival in a region with high discharge survival following OHCA require further study in order to identify survivors at subsequent highest risk.<br />Methods: All patients with OHCA arrest in Olmsted County Minnesota between 1990 and 2000 who received defibrillation of VF by emergency services were included in the population-based study. Baseline patient admission characteristics in survivor and nonsurvivor groups were compared. Survivors to hospital discharge were prospectively followed to determine long-term survival.<br />Results: Two hundred patients suffered a VF arrest. Of these patients, 145 (73%) survived to hospital admission (7 died within the emergency department) and 79 (40%) were subsequently discharged. Sixty-six (83%) were male, with an average age of 61.9 +/- 15.9 years. Univariate predictors of in-hospital mortality included call-to-shock time (6.6 vs. 5.5 min, p = 0.002), a nonwitnessed arrest (75.4 vs. 92.4%, p = 0.008), in-field use of epinephrine (27.8 vs. 93.4%, p < 0.001), age (68.1 vs. 61.9 years, p = 0.017), hypertension (36.1 vs. 14.1%, p = 0.005), ejection fraction (32.4 vs. 42.4, p = 0.012), and use of digoxin (34.9 vs. 12.7%, p = 0.002). Of all these variables, hypertension [hazard ratio (HR) 4.0, 95% CI 1.1-14.1, p = 0.03], digoxin use (HR 4.5, 95% CI 1.3-15.6, p = 0.02), and epinephrine requirement (HR 62.0, 95% CI 15.1-254.8, p < 0.001) were multivariate predictors of in-hospital mortality. Nineteen patients (24%) had died prior to the survey follow-up. Five patients experienced a cardiac death, resulting in a 5-year expected cardiac survival of 92%. Multivariate variables predictive of long-term mortality include digoxin use (HR 3.02, 95% CI 1.80-5.06, p < 0.001), hypertension (HR 2.06, 95% CI 2.12-3.45, p = 0.006), and call-to-shock time (HR 1.18, 95% CI 1.01-1.38, p = 0.038).<br />Conclusion: A combined police/fire/EMS defibrillation program has resulted in an increase of patients surviving to hospital admission after OHCA. This study confirms the need to decrease call-to-shock times, which influence both in-hospital and long-term mortality. This study also identifies the novel demographic variables of digoxin and hypertension, which were also independent risk factors of increased in-hospital and long-term mortality. Identification of these variables may provide utility in identifying those at high-risk of subsequent mortality after resuscitation.<br /> (Copyright 2004 S. Karger AG, Basel)
- Subjects :
- Aged
Aged, 80 and over
Anti-Arrhythmia Agents administration & dosage
Digoxin administration & dosage
Emergency Medical Services
Female
Heart Arrest etiology
Heart Arrest therapy
Humans
Hypertension complications
Male
Middle Aged
Predictive Value of Tests
Research Design
Risk Factors
Survival Analysis
Time Factors
Treatment Outcome
Ventricular Fibrillation complications
Ventricular Fibrillation therapy
Electric Countershock
Heart Arrest mortality
Hospital Mortality
Patient Admission
Ventricular Fibrillation mortality
Subjects
Details
- Language :
- English
- ISSN :
- 0008-6312
- Volume :
- 102
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 14988618
- Full Text :
- https://doi.org/10.1159/000077003