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Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management.
Scand Cardiovasc J 2018; 52(3):133-140SC

Abstract

OBJECTIVE

Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM).

DESIGN

Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002-2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI).

RESULTS

A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p < .001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p < .001, witnessed: 79% vs. 90%, p < .001, bystander CPR: 47% vs. 63%, p < .001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2-2.9), p < .01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55-1.2), p = .34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present.

CONCLUSION

A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm.

Authors+Show Affiliations

a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark. b Department of Anaesthesiology , Central Denmark Regional Hospital Horsens , Horsens , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.c Department of Thoracic Anaesthesiology, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark.a Department of Cardiology 2142, The Heart Centre , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark. d Department of Cardiology , Zealand University Hospital , Roskilde , Denmark.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29553891

Citation

Salam, Idrees, et al. "Importance of Comorbidities in Comatose Survivors of Shockable and Non-shockable Out-of-hospital Cardiac Arrest Treated With Target Temperature Management." Scandinavian Cardiovascular Journal : SCJ, vol. 52, no. 3, 2018, pp. 133-140.
Salam I, Thomsen JH, Kjaergaard J, et al. Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management. Scand Cardiovasc J. 2018;52(3):133-140.
Salam, I., Thomsen, J. H., Kjaergaard, J., Bro-Jeppesen, J., Frydland, M., Winther-Jensen, M., ... Søholm, H. (2018). Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management. Scandinavian Cardiovascular Journal : SCJ, 52(3), pp. 133-140. doi:10.1080/14017431.2018.1450991.
Salam I, et al. Importance of Comorbidities in Comatose Survivors of Shockable and Non-shockable Out-of-hospital Cardiac Arrest Treated With Target Temperature Management. Scand Cardiovasc J. 2018;52(3):133-140. PubMed PMID: 29553891.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Importance of comorbidities in comatose survivors of shockable and non-shockable out-of-hospital cardiac arrest treated with target temperature management. AU - Salam,Idrees, AU - Thomsen,Jakob Hartvig, AU - Kjaergaard,Jesper, AU - Bro-Jeppesen,John, AU - Frydland,Martin, AU - Winther-Jensen,Matilde, AU - Køber,Lars, AU - Wanscher,Michael, AU - Hassager,Christian, AU - Søholm,Helle, Y1 - 2018/03/19/ PY - 2018/3/20/pubmed PY - 2018/10/10/medline PY - 2018/3/20/entrez KW - Non-shockable primary rhythm KW - Targeted Temperature Management KW - comorbidity KW - mortality KW - out-of-hospital cardiac arrest KW - shockable primary rhythm SP - 133 EP - 140 JF - Scandinavian cardiovascular journal : SCJ JO - Scand. Cardiovasc. J. VL - 52 IS - 3 N2 - OBJECTIVE: Comorbidity prior to out-of-hospital cardiac arrest (OHCA) and primary rhythm in relation to survival is not well established. We aimed to assess the prognostic importance of comorbidity in relation to primary rhythm in OHCA-patients treated with Target Temperature Management (TTM). DESIGN: Consecutive comatose survivors of OHCA treated with TTM in hospitals in the Copenhagen area between 2002-2011 were included. Utstein-based pre- and in-hospital data collection was performed. Data on comorbidity was obtained from The Danish National Patient Register and patient charts, assessed by the Charlson Comorbidity Index (CCI). RESULTS: A total of 666 patients were included. A third (n = 233, 35%) presented with non-shockable rhythm, and they were less often male (64% vs. 82%, p < .001), and OHCA in public, witnessed OHCA, and bystander cardiopulmonary resuscitation (CPR) were less common compared to patients with a shockable primary rhythm (public: 27% vs. 48%, p < .001, witnessed: 79% vs. 90%, p < .001, bystander CPR: 47% vs. 63%, p < .001). 30-day mortality was 62% compared to 28% in patients with non-shockable and shockable rhythm, respectively. By Cox-regression analyses, any comorbidity (CCI ≥1) was the only factor independently associated with 30-day mortality in patients with non-shockable rhythm (HR =1.9 (95% CI: 1.2-2.9), p < .01), whereas in patients with shockable rhythm comorbidity was not associated with outcome after adjustment for prognostic factors (HR = 0.82 (0.55-1.2), p = .34). No significant interaction between primary rhythm and comorbidity in terms of mortality was present. CONCLUSION: A higher comorbidity burden was independently associated with a higher 30-day mortality rate in patients presenting with non-shockable primary rhythm but not in patients with shockable rhythm. SN - 1651-2006 UR - https://www.unboundmedicine.com/medline/citation/29553891/Importance_of_comorbidities_in_comatose_survivors_of_shockable_and_non_shockable_out_of_hospital_cardiac_arrest_treated_with_target_temperature_management_ L2 - http://www.tandfonline.com/doi/full/10.1080/14017431.2018.1450991 DB - PRIME DP - Unbound Medicine ER -