Clinical paperRearrest during hospitalisation in adult comatose out-of-hospital cardiac arrest patients: Risk factors and prognostic impact, and predictors of favourable long-term outcomes☆
Introduction
Most out-of-hospital cardiac arrest (OHCA) survivors fail to achieve favourable long-term outcomes.1 A significant proportion of OHCA survivors experience rearrest during their hospitalisation after OHCA.2., 3., 4., 5. Multiple studies have suggested that rearrest hinders survival to hospital discharge.5., 6., 7.
It is important to identify the predictors of rearrest that can be determined in the hours immediately after restoration of spontaneous circulation (ROSC). This may help identify patients at high risk of rearrest and thus enable targeted in-hospital management. When rearrest occurs during hospitalisation, patients’ families and physicians may have overly pessimistic estimates of prognosis, which may lead to inappropriate limitation of active treatment. To identify patients likely to achieve favourable long-term outcomes and guide in-hospital treatment, it is important to determine the predictors of favourable long-term outcomes for patients resuscitated from rearrest. Although several previous studies have investigated these factors,2., 3., 4., 5., 6., 7., 8., 9., 10., 11., 12., 13., 14., 15. the knowledge about these predictors remains limited. Most of the previous studies focused on rearrest before hospital arrival,6., 7., 9., 10., 11., 12., 13., 14., 15. and only few of them have investigated rearrest during hospitalisation after OHCA.2., 3., 4. In addition, most earlier studies assessed only short-term outcomes, such as survival to hospital discharge.14., 2., 3., 4., 5., 6., 7., 8., 9., 10., 11., 12.
In this study, we determined (1) the predictors of rearrest during hospitalisation after OHCA that can be identified in the hours immediately after OHCA, (2) the association between rearrest and long-term outcomes, and (3) the predictors of favourable long-term outcomes in patients resuscitated from first rearrest.
Section snippets
Study design and setting
We retrospectively analysed data from the Korean Hypothermia Network prospective registry, which comprised details of adult OHCA patients treated with targeted temperature management (TTM) from 22 teaching hospitals in the Republic of Korea.16 Collection and subsequent analyses of the data were approved by the institutional review board of each participating hospital, and written informed consent was obtained from all patients’ legal surrogates.
Study population
Between October 2015 and December 2018,
Results
Among 10,258 patients who were screened during the study period, 1,373 were enrolled in the registry (Supplemental Fig. 1). After exclusion of patients enrolled from six hospitals without data regarding rearrest (N = 140), 1,233 patients were included in this study. Among them, 260 (21.1%) experienced at least one episode (median, two episodes; interquartile range, 1–2) of rearrest during their hospitalisation. Variations in key characteristics across participating hospitals are shown in
Discussion
Our study showed that: 1) comorbidities including heart failure and arrhythmia, ST-segment elevation on initial ECG, lower initial GCS motor score, higher initial lactate level, and antiarrhythmic drug use within 1 h were significantly associated with rearrest during hospitalisation after OHCA; 2) rearrest was significantly associated with a lower likelihood of 6-month favourable outcomes; and 3) initial shockable rhythm after OHCA, absence of diabetes, shorter cumulative time to ROSC, CAG, and
Conclusions
Rearrest during hospitalisation after OHCA was common and inversely associated with 6-month favourable outcomes. Further, we identified several risk factors for rearrest and prognostic factors for patients resuscitated from first rearrest.
CRediT authorship contribution statement
Yong Hun Jung: Investigation, Writing – original draft. Kyung Woon Jeung: Conceptualization, Funding acquisition, Writing – original draft. Hyoung Youn Lee: Methodology, Writing – review & editing. Byung Kook Lee: Formal analysis, Writing – review & editing. Dong Hun Lee: Formal analysis, Writing – review & editing. Jonghwan Shin: Investigation, Writing – review & editing. Hui Jai Lee: Investigation, Writing – review & editing. In Soo Cho: Investigation, Writing – review & editing. Young-Min
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
This study was supported by a grant (BCRI21040) from the Chonnam National University Hospital Biomedical Research Institute. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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This study was approved by the Institutional Review Board of each participating hospital. Chonnam National University Hospital Institutional Review Board Protocol No. CNUH-2015–164.