LOS ANGELES -- Patients who experienced the loss of pulses after the successful return of spontaneous circulation were more likely to die at hospital discharge, researchers reported here.
Based on case data from the Resuscitation Outcomes Consortium, patients who had unresolved prehospital re-arrest after an out-of-hospital cardiac arrest had greater than six-fold odds of death prior to hospital discharge (OR 6.14, 95% CI 4.32 to 8.75, P<0.001), according to David Salcido, MPH, of the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues.
While the incidence of re-arrest was relatively uncommon in this study population, survival was 7.8% among cases of unresolved pre-hospital re-arrest versus 33.3% in cases without, Salcido reported at the American Heart Association meeting. The overall survival to hospital discharge was 28%.
The results are preliminary, but the take-home message is that patient resuscitation does not necessarily mean "they're of the woods completely. Re-arrest is real and strongly predictive of death," Salcido said.
The phenomenon of re-arrest is important because even transient loss of pulses prior to hospital arrival may have a detrimental impact on patient outcomes, the authors explained.
Patients who experience re-arrest may also demonstrate specific pathology, the identification and treatment of which may lead to better outcomes, they added.
The group analyzed 11,456 out-of-hospital cardiac arrest cases from 2006 to 2008 from a 10-site cardiac arrest surveillance program, which included patients treated with successful return of spontaneous circulation by nontraumatic emergency medical services.
They included data on prehospital resuscitation events, patient vital status when admitted to the emergency department, survival at discharge, patient demographics, and additional variables on resuscitation. Data were derived from paramedic reports, defibrillator data downloads, and hospital records, they noted.
On average, patients were older than 60 (mean age 63.7) and male (62.9%). Less than a quarter of patients experienced cardiac arrest in public (21.5%), and less than half of the patients were successfully resuscitated before arriving at the hospital (40.2%). Unresolved re-arrest occurred in 15.2% of patients.
The authors also found that when comparing patients with unresolved re-arrest to those without, the former group were:
- Less likely to present with a first ventricular fibrillation: 39.7% versus 44.4% (P=0.03)
- More likely to undergo shock: 59.6% versus 51.1% (P=0.0002)
- More likely to receive a higher number of shocks: Mean 4.5 shocks versus 3 (P<0.0001)
- More likely to have received epinephrine (87.6% versus 79.3% (P<0.0001)
Salcido said that this study may be the first to label the condition as unresolved prehospital re-arrest, but added that "we need more research." Co-author James Menegazzi, PhD, agreed.
"This is largely an unstudied phenomenon and we're really kind of the first people to shine a light on it, so hopefully ... we can get more people to pay attention to it," he said.
Salcido noted that follow-up research will create a generalized picture of rearrest, its effects on survival, and potential mechanisms to prevent it.
SOURCE: Med Page Today