Neurological outcome in adult out-of-hospital cardiac arrest - Not all doom and gloom!

Nicole Mckenzie; Stephen Ball; Paul Bailey; Lyndall Finn; Glenn Arendts; Antonio Celenza; Daniel Fatovich; Ian Jenkins; Ashes Mukherjee; Ben Smedley; Nicole Ghedina; Janet Bray; Kwok M Ho; Geoffrey Dobb; Judith Finn

doi:10.1016/j.resuscitation.2021.08.042

Neurological outcome in adult out-of-hospital cardiac arrest - Not all doom and gloom!

Resuscitation. 2021 Oct:167:227-232. doi: 10.1016/j.resuscitation.2021.08.042. Epub 2021 Sep 1.

Authors

Nicole Mckenzie¹, Stephen Ball², Paul Bailey², Lyndall Finn³, Glenn Arendts⁴, Antonio Celenza⁵, Daniel Fatovich⁶, Ian Jenkins⁷, Ashes Mukherjee⁸, Ben Smedley⁹, Nicole Ghedina¹⁰, Janet Bray¹¹, Kwok M Ho¹², Geoffrey Dobb¹³, Judith Finn¹⁴

Affiliations

¹ Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia. Electronic address: nicole.mckenzie@curtin.edu.au.
² Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia.
³ Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia.
⁴ Medical School, University of Western Australia, Crawley, WA, Australia; Fiona Stanley Hospital, Murdoch, WA, Australia.
⁵ Medical School, University of Western Australia, Crawley, WA, Australia; Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
⁶ Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA, Australia.
⁷ Fremantle Hospital, Fremantle, WA, Australia.
⁸ Armadale Health Service, Armadale, WA, Australia.
⁹ Rockingham General Hospital, Rockingham WA, Australia.
¹⁰ St John of God Hospital Midland, Midland, WA, Australia.
¹¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹² Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia; St John of God Hospital Subiaco, Subiaco, WA, Australia; School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia.
¹³ Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia.
¹⁴ Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Western Australia, Belmont, WA, Australia; Medical School, University of Western Australia, Crawley, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

PMID: 34480975
DOI: 10.1016/j.resuscitation.2021.08.042

Abstract

Aims: To describe neurological and functional outcomes among out-of-hospital cardiac arrest (OHCA) patients who survived to hospital discharge; to determine the association between neurological outcome at hospital discharge and 12-month survival.

Methods: Our cohort comprised adult OHCA patients (≥18 years) attended by St John WA (SJWA) paramedics in Perth, Western Australia (WA), who survived to hospital discharge, between 1st January 2004 and 31st December 2019. Neurological and functional status at hospital discharge (and before the arrest) was determined by medical record review using the five-point 'Cerebral Performance Category (CPC)' and 'Overall Performance Category (OPC)' scores. Adjusted multivariable logistic regression analysis was used to estimate the association of CPC score at hospital discharge with 12-month survival, adjusted for prognostic variables.

Results: Over the study period, SJWA attended 23,712 OHCAs. Resuscitation was attempted in 43.4% of cases (n = 10,299) with 2171 subsequent admissions, 99.4% (n = 2158) of these were admitted to a study hospital. Of the 1062 hospital survivors, 71.3% (n = 757) were CPC1 (highest category of neurological performance), 21.4% (n = 227) CPC2, 6.3% (n = 67) CPC3 and 1.0% (n = 11) CPC4. OPC scores followed a similar distribution. Of the 1,011 WA residents who survived to hospital discharge, 92.3% (n = 933) survived to 12-months. A CPC1-2 at hospital discharge was significantly associated with 12-month survival (adjusted odds ratio 3.28, 95% confidence interval 1.69-6.39).

Conclusion: Whilst overall survival is low, most survivors of OHCA have a good neurological outcome at hospital discharge and are alive at 12-months.

Keywords: Cerebral performance category; Neurological outcome; Out-of-hospital cardiac arrest; Overall performance category; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Allied Health Personnel
Cardiopulmonary Resuscitation*
Cohort Studies
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Patient Discharge