Michael Yih-Chong Chia1, Qing Shu Lu2, Nik Hisamuddin Rahman3, Nausheen Edwin Doctor4, Tatsuya Nishiuchi5, Benjamin Sieu-Hon Leong6, Lai Peng Tham7, E-Shaun Goh8, Ling Tiah9, Apichaya Monsomboon10, Marcus Eng Hock Ong11. 1. Emergency Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. Electronic address: Michael_Yc_Chia@ttsh.com.sg. 2. Singapore Clinical Research Institute Pte Ltd., 31 Biopolis Way, Nanos #02-01, Singapore 138669, Singapore. 3. Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia. 4. Emergency Department, Sengkang Health, 378 Alexandra Road, Singapore 159964, Singapore. 5. Department of Acute Medicine, Kindai University Faculty of Medicine, 3-4-1 Kowakae, Higashiosaka City, Osaka 577-8502, Japan. 6. Emergency Medicine Department, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. 7. Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore. 8. Emergency Medicine, Raffles Medical Group, 585 North Bridge Road, Singapore 188770, Singapore. 9. Accident and Emergency Department, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore. 10. Emergency Medicine Unit, Faculty of Internal Medicine, Siriraj Hospital, Bangkoknoi, Bangkok 10700, Thailand. 11. Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore.
Abstract
BACKGROUND: There is paucity of data examining the incidence and outcomes of young OHCA adults. The aim of this study is to determine the outcomes and characteristics of young adults who suffered an OHCA and identify factors that are associated with favourable neurologic outcomes. METHODS: All EMS-attended OHCA adults between the ages of 16 and 35 years in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry were analysed. The primary outcome was favourable neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge or at 30th day post OHCA if not discharged. Regression analysis was performed to identify factors associated with favourable neurologic outcomes. RESULTS: 66,780 OHCAs were collected between January 2009 and December 2013; 3244 young OHCAs had resuscitation attempted by emergency medical services (EMS). 56.8% of patients had unwitnessed arrest; 47.9% were of traumatic etiology. 17.2% of patients (95% CI: 15.9-18.5%) had return of spontaneous circulation; 7.8% (95% CI: 6.9-8.8%) survived to one month; 4.6% (95% CI: 4.0-5.4%) survived with favourable neurologic outcomes. Factors associated with favourable neurologic outcomes include witnessed arrest (adjusted RR=2.42, p-value<0.0001), bystander CPR (adjusted RR=1.57, p-value=0.004), first arrest shockable rhythm (adjusted RR=27.24, p-value<0.0001), and cardiac etiology (adjusted RR=3.99, p-value<0.0001). CONCLUSIONS: OHCA among young adults are not uncommon. Traumatic OHCA, occurring most frequently in young adults had dismal prognosis. First arrest rhythms of VF/VT/unknown shockable rhythm, cardiac etiology, bystander-witnessed arrest, and bystander CPR were associated with favourable neurological outcomes. The results of the study would be useful for planning preventive and interventional strategies, improving EMS, and guiding future research.
BACKGROUND: There is paucity of data examining the incidence and outcomes of young OHCA adults. The aim of this study is to determine the outcomes and characteristics of young adults who suffered an OHCA and identify factors that are associated with favourable neurologic outcomes. METHODS: All EMS-attended OHCA adults between the ages of 16 and 35 years in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry were analysed. The primary outcome was favourable neurologic outcome (Cerebral Performance Category 1 or 2) at hospital discharge or at 30th day post OHCA if not discharged. Regression analysis was performed to identify factors associated with favourable neurologic outcomes. RESULTS: 66,780 OHCAs were collected between January 2009 and December 2013; 3244 young OHCAs had resuscitation attempted by emergency medical services (EMS). 56.8% of patients had unwitnessed arrest; 47.9% were of traumatic etiology. 17.2% of patients (95% CI: 15.9-18.5%) had return of spontaneous circulation; 7.8% (95% CI: 6.9-8.8%) survived to one month; 4.6% (95% CI: 4.0-5.4%) survived with favourable neurologic outcomes. Factors associated with favourable neurologic outcomes include witnessed arrest (adjusted RR=2.42, p-value<0.0001), bystander CPR (adjusted RR=1.57, p-value=0.004), first arrest shockable rhythm (adjusted RR=27.24, p-value<0.0001), and cardiac etiology (adjusted RR=3.99, p-value<0.0001). CONCLUSIONS: OHCA among young adults are not uncommon. Traumatic OHCA, occurring most frequently in young adults had dismal prognosis. First arrest rhythms of VF/VT/unknown shockable rhythm, cardiac etiology, bystander-witnessed arrest, and bystander CPR were associated with favourable neurological outcomes. The results of the study would be useful for planning preventive and interventional strategies, improving EMS, and guiding future research.
Authors: Niek Johannes Vianen; Esther Maria Maartje Van Lieshout; Iscander Michael Maissan; Wichor Matthijs Bramer; Dennis Den Hartog; Michael Herman Jacob Verhofstad; Mark Gerrit Van Vledder Journal: Eur J Trauma Emerg Surg Date: 2022-03-25 Impact factor: 2.374