Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management

Idrees Salam*, Jakob Hartvig Thomsen, Jesper Kjaergaard, John Bro-Jeppesen, Martin Frydland, Matilde Winther-Jensen, Lars Køber, Michael Wanscher, Christian Hassager, Helle Søholm

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalScandinavian Cardiovascular Journal
Volume52
Issue number3
Pages (from-to)133-140
ISSN1401-7431
DOIs
Publication statusPublished - Jun 2018
Externally publishedYes

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Survivors
Comorbidity
Regression Analysis

Keywords

  • comorbidity
  • mortality
  • Non-shockable primary rhythm
  • out-of-hospital cardiac arrest
  • shockable primary rhythm
  • Targeted Temperature Management
  • Multivariate Analysis
  • Humans
  • Middle Aged
  • Male
  • Time Factors
  • Female
  • Registries
  • Retrospective Studies
  • Out-of-Hospital Cardiac Arrest/diagnosis
  • Hypothermia, Induced/adverse effects
  • Heart Rate
  • Comorbidity
  • Risk Factors
  • Body Temperature Regulation
  • Kaplan-Meier Estimate
  • Proportional Hazards Models
  • Treatment Outcome
  • Electric Countershock/adverse effects
  • Cardiopulmonary Resuscitation/adverse effects
  • Denmark
  • Coma/diagnosis
  • Aged

Cite this

Salam, Idrees ; Thomsen, Jakob Hartvig ; Kjaergaard, Jesper ; Bro-Jeppesen, John ; Frydland, Martin ; Winther-Jensen, Matilde ; Køber, Lars ; Wanscher, Michael ; Hassager, Christian ; Søholm, Helle. / Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management. In: Scandinavian Cardiovascular Journal. 2018 ; Vol. 52, No. 3. pp. 133-140.
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abstract = "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.",
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author = "Idrees Salam and Thomsen, {Jakob Hartvig} and Jesper Kjaergaard and John Bro-Jeppesen and Martin Frydland and Matilde Winther-Jensen and Lars K{\o}ber and Michael Wanscher and Christian Hassager and Helle S{\o}holm",
year = "2018",
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language = "English",
volume = "52",
pages = "133--140",
journal = "Scandinavian Cardiovascular Journal",
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Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management. / Salam, Idrees; Thomsen, Jakob Hartvig; Kjaergaard, Jesper; Bro-Jeppesen, John; Frydland, Martin; Winther-Jensen, Matilde; Køber, Lars; Wanscher, Michael; Hassager, Christian; Søholm, Helle.

In: Scandinavian Cardiovascular Journal, Vol. 52, No. 3, 06.2018, p. 133-140.

Research output: Contribution to journalJournal articleResearchpeer-review

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

VL - 52

SP - 133

EP - 140

JO - Scandinavian Cardiovascular Journal

JF - Scandinavian Cardiovascular Journal

SN - 1401-7431

IS - 3

ER -