I Efendijev

M Reinikainen

MB Skrifvars

R Raj

S Hoppu

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POSTER PRESENTATION Open Access
Differences in long-term mortality after out-of-
hospital, in-hospital and intensive care unit
cardiac arrests in Finland
I Efendijev1,2*, R Raj1,2, M Reinikainen3, S Hoppu4,5, MB Skrifvars1,2
From ESICM LIVES 2015
Berlin, Germany. 3-7 October 2015
Introduction
Despite significant number of studies on cardiac arrest
(CA), long-term outcome data are still scarce.
Objectives
To determine long-term mortality after cardiac arrest in
patients treated in Finnish university hospitals’ intensive
care units (ICU) stratified by arrest location.
Methods
We performed a retrospective registry based study on
adult patients treated in five Finnish university hospitals’
ICUs between 2003 and 2013. We included patients
with admission diagnosis of cardiac arrest according to
the Acute Physiology and Chronic Health Evaluation III
(APACHE III) and patients with positive value for Ther-
apeutic Intervention Scoring System (TISS-76) item
“cardiac arrest and/or countershock within past 48
hours”. Patients were classified by cardiac arrest location
as out-of-hospital cardiac arrests (OHCA), in-hospital
cardiac arrests (IHCA) and intensive care unit cardiac
arrests (ICU-CA). Data on long-term outcome were
retrieved from Finnish Population Register Centre. We
excluded re-admissions and cases with missing baseline
data. We calculated crude long-term mortality using life
tables for the whole population and for patients who
survived initial 30 days. The median time to death with
interquartile range (IQR) was calculated for the non-
survivors and compared between cardiac arrest location
groups using Kruskal-Wallis test with pairwise compari-
son. In order to determine independent association of
cardiac arrest location with mortality, we used Cox
regression with case mix adjustment using pre-admission
functional status, Simplified Acute Physiology Score II
(SAPS II), chronic comorbidities, age, admission type
(emergency and operative) and admission year.
Results
Median follow-up time was 5.4 years (IQR 2.7-8.0). During
the study period there were 2,413 OHCAs, 1,362 IHCAs
and 1,952 ICU-CAs. For the general population one-year
crude mortality was: OHCA 59%, IHCA 53% and ICU-CA
56%, five-year mortality was respectively: OHCA 67%,
IHCA 64% and ICU-CA 67%. For patients with initial sur-
vival over 30 days one-year mortality was: OHCA 18%,
IHCA 21%, ICU-CA 21% and five-year mortality was:
OHCA 34%, IHCA 40%, ICU-CA 40%. Median time to
death was 3.6 days (IQR 1.2-19.7) for OHCAs, 4.4 days
(IQR 1.0-58.7) for IHCAs and 3 days (IQR 0.1-28.9) for
ICU-CAs. There was significant difference for median
time to death between ICU-CA and two other groups
(p = 0.002 vs. OHCA and p < 0.001 vs. IHCA). In compar-
ison to OHCA, IHCA was associated with a lower risk of
death (hazard ratio [HR] 0.90, 95% confidence interval
[CI] 0.82-0.99, p = 0.02), while risk of death for ICU-CA
was similar (HR 1.09, 95% CI 1.00-1.19, p = 0.06).
Conclusions
In this large retrospective study we have determined long-
term mortality of cardiac arrest patients treated in university
hospitals’ ICUs stratified by arrest location. Among all ICU-
treated CA patients, long-term survival of IHCA patients
was better than that of OHCA and ICU-CA patients.
Authors’ details
1Helsinki University Central Hospital, Helsinki, Finland. 2University of Helsinki,
Helsinki, Finland. 3North Karelia Central Hospital, Joensuu, Finland. 4Tampere
1Helsinki University Central Hospital, Helsinki, Finland
Full list of author information is available at the end of the article
Efendijev et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A846
http://www.icm-experimental.com/content/3/S1/A846
© 2015 Efendijev et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
University Hospital, Tampere, Finland. 5University of Tampere, Tampere,
Finland.
Published: 1 October 2015
doi:10.1186/2197-425X-3-S1-A846
Cite this article as: Efendijev et al.: Differences in long-term mortality
after out-of-hospital, in-hospital and intensive care unit cardiac arrests
in Finland. Intensive Care Medicine Experimental 2015 3(Suppl 1):A846.
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Efendijev et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A846
http://www.icm-experimental.com/content/3/S1/A846
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DIFFERENCES IN LONG-TERM MORTALITY AFTER OUT-OF-HOSPITAL, IN-HOSPITAL AND INTENSIVE CARE UNIT CARDIAC ARRESTS IN FINLAND

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DIFFERENCES IN LONG-TERM MORTALITY AFTER OUT-OF-HOSPITAL, IN-HOSPITAL AND INTENSIVE CARE UNIT CARDIAC ARRESTS IN FINLAND

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