TY - JOUR
T1 - Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management
AU - Salam, Idrees
AU - Thomsen, Jakob Hartvig
AU - Kjaergaard, Jesper
AU - Bro-Jeppesen, John
AU - Frydland, Martin
AU - Winther-Jensen, Matilde
AU - Køber, Lars
AU - Wanscher, Michael
AU - Hassager, Christian
AU - Søholm, Helle
PY - 2018/6
Y1 - 2018/6
N2 - OBJECTIVE: Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM).DESIGN: Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002-2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI).RESULTS: A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p < .001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p < .001, witnessed: 79% vs. 90%, p < .001, bystander CPR: 47% vs. 63%, p < .001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2-2.9), p < .01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55-1.2), p = .34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present.CONCLUSION: A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm.
AB - OBJECTIVE: Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM).DESIGN: Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002-2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI).RESULTS: A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p < .001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p < .001, witnessed: 79% vs. 90%, p < .001, bystander CPR: 47% vs. 63%, p < .001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2-2.9), p < .01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55-1.2), p = .34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present.CONCLUSION: A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm.
KW - comorbidity
KW - mortality
KW - Non-shockable primary rhythm
KW - out-of-hospital cardiac arrest
KW - shockable primary rhythm
KW - Targeted Temperature Management
KW - Multivariate Analysis
KW - Humans
KW - Middle Aged
KW - Male
KW - Time Factors
KW - Female
KW - Registries
KW - Retrospective Studies
KW - Out-of-Hospital Cardiac Arrest/diagnosis
KW - Hypothermia, Induced/adverse effects
KW - Heart Rate
KW - Comorbidity
KW - Risk Factors
KW - Body Temperature Regulation
KW - Kaplan-Meier Estimate
KW - Proportional Hazards Models
KW - Treatment Outcome
KW - Electric Countershock/adverse effects
KW - Cardiopulmonary Resuscitation/adverse effects
KW - Denmark
KW - Coma/diagnosis
KW - Aged
U2 - 10.1080/14017431.2018.1450991
DO - 10.1080/14017431.2018.1450991
M3 - Journal article
C2 - 29553891
AN - SCOPUS:85044185113
SN - 1401-7431
VL - 52
SP - 133
EP - 140
JO - Scandinavian Cardiovascular Journal
JF - Scandinavian Cardiovascular Journal
IS - 3
ER -