Predicting Survival After Out-of-Hospital Cardiac Arrest

Summary and Comment |
March 28, 2014

Predicting Survival After Out-of-Hospital Cardiac Arrest

  1. Kristi L. Koenig, MD, FACEP, FIFEM

In patients with ST-elevation myocardial infarction and return of spontaneous circulation, level of consciousness at hospital arrival was prognostic.

  1. Kristi L. Koenig, MD, FACEP, FIFEM

Information about a patient's neurological status at least 24 hours after an out-of-hospital cardiac arrest (OHCA) can be used to predict survival. But what data would be prognostic at the time of hospital arrival? To assess whether level of consciousness at arrival to an emergency department (ED) is associated with recovery after OHCA, investigators performed a retrospective review of 452 patients with nontraumatic OHCA who achieved return of spontaneous circulation and were transported to an ST-elevation myocardial infarction (STEMI) center in London during a 2-year period. Median time from call for help to hospital arrival was 66 minutes.

A total of 253 patients (56%) survived to hospital discharge. Reduced consciousness at ED arrival was associated with longer hospital stay, and fewer unresponsive patients than alert patients survived (39% vs. 91%). Most patients (79%) had shockable rhythms; more of these patients than those with nonshockable rhythms were alert or responsive to verbal stimuli (32% vs. 9%).

Comment

When discussing prognosis with family members of patients with ST-elevation myocardial infarction, it is useful to know that nearly all patients who were responsive at hospital admission survived to discharge. Given that many unconscious STEMI patients also had a good prognosis, level of consciousness should not influence or alter planning for percutaneous coronary intervention.

Editor Disclosures at Time of Publication

  • Disclosures for Kristi L. Koenig, MD, FACEP, FIFEM at time of publication Grant / research support State of California Editorial boards Koenig & Schultz's Disaster Medicine: Comprehensive Principles and Practices Leadership positions in professional societies World Association of Disaster and Emergency Medicine (Board of Directors)

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