Elsevier

Resuscitation

Volume 170, January 2022, Pages 150-159
Resuscitation

Clinical paper
Rearrest during hospitalisation in adult comatose out-of-hospital cardiac arrest patients: Risk factors and prognostic impact, and predictors of favourable long-term outcomes

https://doi.org/10.1016/j.resuscitation.2021.11.037Get rights and content

Abstract

Background

Rearrest occurs commonly after initial resuscitation following out-of-hospital cardiac arrest (OHCA). We determined (1) the predictors of rearrest during hospitalisation that can be identified in the hours immediately after OHCA, (2) the association between rearrest and favourable long-term outcomes, and (3) the predictors of favourable long-term outcomes in rearrest patients.

Methods

Conditional multivariable logistic regression analyses were performed using the Korean Hypothermia Network prospective registry data, which included details of adult OHCA patients treated with targeted temperature management at 22 teaching hospitals in South Korea.

Results

Among the 1,233 patients, 260 (21.1%) experienced rearrest. Of the 192 patients resuscitated from first rearrest, 33 (17.2%) achieved 6-month favourable outcomes. Arrhythmia, heart failure, ST-segment elevation, lower initial Glasgow coma scale (GCS) motor score, higher initial lactate level, and antiarrhythmic drug use within 1 h were independently associated with rearrest. Higher lactate level and antiarrhythmic drug use were associated with shockable first rearrest, while arrhythmia, heart failure, ST-segment elevation, and lower GCS motor score were associated with non-shockable first rearrest. Rearrest was independently associated with a lower likelihood of 6-month favourable outcomes (P = 0.003). Initial shockable rhythm after OHCA, absence of diabetes, shorter cumulative time to restoration of spontaneous circulation, coronary angiography, and hypophosphataemia within 7 d were independently associated with 6-month favourable outcomes in the patients resuscitated from first rearrest.

Conclusions

Rearrest during hospitalisation after OHCA was inversely associated with 6-month favourable outcomes. We identified several risk factors for rearrest and prognostic factors for patients resuscitated from first rearrest.

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.

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