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ORIGINAL ARTICLE   Free accessfree

Minerva Anestesiologica 2019 July;85(7):738-45

DOI: 10.23736/S0375-9393.18.12878-1


language: English

Out-of-hospital cardiac arrest at place of residence is associated with worse outcomes in patients admitted to intensive care. A post-hoc analysis of the targeted temperature management trial

Cecilia ANDRÉLL 1, 2 , Josef DANKIEWICZ 1, 3, Christian HASSAGER 4, Janneke HORN 5, Jesper KJÆRGAARD 4, Matilde WINTHER-JENSEN 4, Matt P. WISE 6, Niklas NIELSEN 1, 7, Pascal STAMMET 8, Hans FRIBERG 1, 2, on behalf of the TTM Trial Investigators

1 Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; 2 Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden 3 Department of Cardiology, Skåne University Hospital, Lund, Sweden; 4 The Heart Center, Copenhagen University Hospital, Copenhagen, Denmark; 5 Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 6 Department of Adult Critical Care, University Hospital of Wales, Cardiff, UK; 7 Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden; 8 Department of Medicine, National Rescue Services, Luxembourg, Luxembourg

BACKGROUND: The majority of out-of-hospital cardiac arrests (OHCAs) occur at place of residence, which is associated with worse outcomes in unselected prehospital populations. Our aim was to investigate whether location of arrest was associated with outcome in a selected group of initial survivors admitted to intensive care.
METHODS: This is a post-hoc analysis of the Targeted Temperature Management After Cardiac Arrest (TTM) trial, a multicenter controlled trial, randomizing 950 OHCA patients to an intervention of 33 °C or 36 °C. The location of cardiac arrest was defined as place of residence versus public place or other. The outcome measures were mortality and neurological outcome, as defined by the Cerebral Performance Category Scale, at 180 days.
RESULTS: Approximately half of 938 included patients arrested at place of residence (53%). Location groups did not differ with respect to age (P=0.11) or witnessed arrests (P=0.48) but bystander CPR was less common (P=0.02) at place of residence. OHCA at place of residence was associated with higher 180-day mortality (55% vs. 38%, P<0.001) and worse neurological outcome (61% vs. 43%, P<0.001) compared with a public place or other. After adjusting for known confounders, OHCA at place of residence remained an independent predictor of mortality (P=0.007).
CONCLUSIONS: Half of all initial survivors after OHCA admitted to intensive care had an arrest at place of residence which was independently associated with poor outcomes. Actions to improve outcomes after OHCA at place of residence should be addressed in future trials.

KEY WORDS: Comorbidity; Mortality; Neurologic manifestations; Induced hypothermia; Out-of-hospital cardiac arrest

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