Jr-Jiun Lin1, Chien-Hua Huang2, Wen-Jone Chen3, Po-Ya Chuang4, Wei-Tien Chang1, Wei-Ting Chen1, Min-Shan Tsai5. 1. Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan. 2. Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan. Electronic address: chhuang5904@ntu.edu.tw. 3. Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan; Department of Internal Medicine (Cardiology Division), National Taiwan University Medical College and Hospital, Taipei, Taiwan. 4. School of Health Care Administration, Taipei Medical University, Taipei, Taiwan. 5. Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan. Electronic address: mshanmshan@gmail.com.
Abstract
BACKGROUND/ PURPOSE: Whether targeted temperature management (TTM) and emergent coronary angiography (CAG) remain associated with better outcomes in patients with prehospital return of spontaneous circulation (ROSC) was unknown. METHODS: This retrospective cohort study enrolled 81 adult, nontraumatic out-of-hospital cardiac arrest patients who had good pre-arrest neurological function and achieved prehospital ROSC during 2012 to August 2017. The outcomes were survival-to-discharge and neurological recovery at discharge. RESULTS: Fifty-five patients (67.9%) survived to hospital discharge (the survivor group) and twenty-six (32.1%) failed (the non-survivor group). A total of 47 patients (58.0%) presented favorable neurological outcomes [Cerebral Performance Category (CPC) score = 1-2, the favorable group], and 34 patients (42.0%) presented unfavorable neurological outcomes (CPC score = 3-5, the poor group). The survivor group had more patients with TTM (45.5% vs. 19.2%, p = 0.023) and emergent CAG (76.4% vs. 19.2%, p < 0.001) than the non-survivor group, and similar findings were noted in the neurological outcomes (TTM: 44.7% vs. 26.5%, p = 0.094; CAG: 80.9% vs. 26.5%, p < 0.001). TTM remained associated with increased survival-to-discharge [odds ratio (OR) = 14.635, 95% confidence interval (CI) = 1.296-165.305, p = 0.030] and a trend toward good neurological recovery (OR = 4.551, 95%CI = 0.963-21.517, p = 0.056). After excluding patients with rapid neurological recovery after ROSC (n = 70), TTM was associated with good neurological outcomes (OR = 4.534, 95% CI = 1.075-19.127, p = 0.040). Emergent CAG had the trend associated with survival-to-discharge (OR = 9.599, 95%CI = 0.764-120.634, p = 0.080) and was significantly associated with good neurological outcomes (OR = 21.785, 95%CI = 2.004-236.836, p = 0.011). CONCLUSION: In patients with prehospital ROSC, both TTM and emergent CAG were associated to improved survival and neurological outcomes.
BACKGROUND/ PURPOSE: Whether targeted temperature management (TTM) and emergent coronary angiography (CAG) remain associated with better outcomes in patients with prehospital return of spontaneous circulation (ROSC) was unknown. METHODS: This retrospective cohort study enrolled 81 adult, nontraumatic out-of-hospital cardiac arrestpatients who had good pre-arrest neurological function and achieved prehospital ROSC during 2012 to August 2017. The outcomes were survival-to-discharge and neurological recovery at discharge. RESULTS: Fifty-five patients (67.9%) survived to hospital discharge (the survivor group) and twenty-six (32.1%) failed (the non-survivor group). A total of 47 patients (58.0%) presented favorable neurological outcomes [Cerebral Performance Category (CPC) score = 1-2, the favorable group], and 34 patients (42.0%) presented unfavorable neurological outcomes (CPC score = 3-5, the poor group). The survivor group had more patients with TTM (45.5% vs. 19.2%, p = 0.023) and emergent CAG (76.4% vs. 19.2%, p < 0.001) than the non-survivor group, and similar findings were noted in the neurological outcomes (TTM: 44.7% vs. 26.5%, p = 0.094; CAG: 80.9% vs. 26.5%, p < 0.001). TTM remained associated with increased survival-to-discharge [odds ratio (OR) = 14.635, 95% confidence interval (CI) = 1.296-165.305, p = 0.030] and a trend toward good neurological recovery (OR = 4.551, 95%CI = 0.963-21.517, p = 0.056). After excluding patients with rapid neurological recovery after ROSC (n = 70), TTM was associated with good neurological outcomes (OR = 4.534, 95% CI = 1.075-19.127, p = 0.040). Emergent CAG had the trend associated with survival-to-discharge (OR = 9.599, 95%CI = 0.764-120.634, p = 0.080) and was significantly associated with good neurological outcomes (OR = 21.785, 95%CI = 2.004-236.836, p = 0.011). CONCLUSION: In patients with prehospital ROSC, both TTM and emergent CAG were associated to improved survival and neurological outcomes.