Wulfran Bougouin1, Florence Dumas2, Nicole Karam1, Carole Maupain3, Eloi Marijon4, Lionel Lamhaut5, Daniel Jost6, Guillaume Geri7, Frankie Beganton8, Olivier Varenne9, Christian Spaulding1, Xavier Jouven1, Alain Cariou10. 1. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Sudden Death Expertise Center, Paris, France. 2. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France. 3. Cardiology Department, Pitié-Salpétrière Hospital, APHP, Paris, France. 4. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Georges Pompidou European Hospital, AP-HP, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Rescu at Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. 5. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France. 6. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Brigade de Sapeurs Pompiers de Paris, Paris, France. 7. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Center, Paris, France. 8. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France. 9. Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Cardiology Department, Cochin Hospital, APHP, Paris, France. 10. Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France. Electronic address: alain.cariou@cch.aphp.fr.
Abstract
OBJECTIVES: This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival. BACKGROUND: An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases. METHODS: From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France). Risk of in-hospital death was retrospectively calculated using the validated Cardiac Arrest Hospital Prognosis score, which includes age, setting, initial rhythm, durations from collapse to basic life support and from basic life support to return of spontaneous circulation, pH, and epinephrine dose. Independent predictors of survival at discharge (including immediate CAG) were assessed in multivariate logistic regression in each of the 3 pre-defined subgroups of Cardiac Arrest Hospital Prognosis score: low risk (<150 points), medium risk (150 to 200 points), and high risk (>200 points) for in-hospital death. RESULTS: A total of 1,410 patients were included and overall survival rate at hospital discharge was 32%. Distribution in the low-, medium-, and high-risk Cardiac Arrest Hospital Prognosis subgroups was 667 (47%), 469 (33%), and 274 patients (20%), respectively. The rate of early CAG was 86%, 66%, and 47% in the low-, medium-, and high-risk subgroups, respectively (p < 0.001). Early invasive strategy was independently associated with better survival in low-risk patients (odds ratio: 2.3; 95% confidence interval: 1.4 to 3.9; p = 0.001), but not in medium-risk (p = 0.55) and high-risk (p = 0.43) patients. Sensitivity analysis found consistent results. CONCLUSIONS: In cardiac arrest patients, our results suggest that investigations regarding early CAG after OHCA should focus on patients with preserved neurological status.
OBJECTIVES: This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival. BACKGROUND: An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases. METHODS: From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France). Risk of in-hospital death was retrospectively calculated using the validated Cardiac Arrest Hospital Prognosis score, which includes age, setting, initial rhythm, durations from collapse to basic life support and from basic life support to return of spontaneous circulation, pH, and epinephrine dose. Independent predictors of survival at discharge (including immediate CAG) were assessed in multivariate logistic regression in each of the 3 pre-defined subgroups of Cardiac Arrest Hospital Prognosis score: low risk (<150 points), medium risk (150 to 200 points), and high risk (>200 points) for in-hospital death. RESULTS: A total of 1,410 patients were included and overall survival rate at hospital discharge was 32%. Distribution in the low-, medium-, and high-risk Cardiac Arrest Hospital Prognosis subgroups was 667 (47%), 469 (33%), and 274 patients (20%), respectively. The rate of early CAG was 86%, 66%, and 47% in the low-, medium-, and high-risk subgroups, respectively (p < 0.001). Early invasive strategy was independently associated with better survival in low-risk patients (odds ratio: 2.3; 95% confidence interval: 1.4 to 3.9; p = 0.001), but not in medium-risk (p = 0.55) and high-risk (p = 0.43) patients. Sensitivity analysis found consistent results. CONCLUSIONS: In cardiac arrestpatients, our results suggest that investigations regarding early CAG after OHCA should focus on patients with preserved neurological status.
Authors: Saraschandra Vallabhajosyula; Abhiram Prasad; Malcolm R Bell; Gurpreet S Sandhu; Mackram F Eleid; Shannon M Dunlay; Gregory J Schears; John M Stulak; Mandeep Singh; Bernard J Gersh; Allan S Jaffe; David R Holmes; Charanjit S Rihal; Gregory W Barsness Journal: Circ Heart Fail Date: 2019-12-12 Impact factor: 8.790
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440