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

<p><i>Objective.</i> 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). <i>Design.</i> 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). <i>Results.</i> A total of 666 patients were included. A third (<i>n</i> = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, <i>p</i> < .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%, <i>p</i> < .001, witnessed: 79% vs. 90%, <i>p</i> < .001, bystander CPR: 47% vs. 63%, <i>p</i> < .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), <i>p</i> < .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), <i>p</i> = .34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present. <i>Conclusion.</i> 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.</p

Predictive values of neuron-specific enolase (NSE) for poor outcome after out-of-hospital cardiac arrest.

<p>Predictive values of neuron-specific enolase (NSE) for poor outcome after out-of-hospital cardiac arrest.</p

Patient inclusion.

<p>Displaying the total Targeted Temperature Management (TTM) population, Intention-To-Treat (ITT) population and outcomes by the Cerebral Performance Category (CPC) scale.</p

Predictive ability of neuron-specific enolase (NSE) for poor outcome after out-of-hospital cardiac arrest.

<p>Receiver Operating Characteristics plots showing the predictive ability of NSE models to predict poor outcome (CPC 3–5) at 180 days after OHCA in patients remaining unconscious at day 3 with inserts showing the enlarged plots for low false-positive rates from zero to five percent (AUCs presented for identical populations).</p

Predictive values of neuron-specific enolase (NSE) with a low false-positive rate.

<p>Predictive values of neuron-specific enolase (NSE) with a low false-positive rate.</p

Base line characteristics stratified by neuron-specific enolase (NSE) -quartiles in 685 included patients.

<p>Base line characteristics stratified by neuron-specific enolase (NSE) -quartiles in 685 included patients.</p