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. 2015 Nov-Dec;133(6):495-501.
doi: 10.1590/1516-3180.2015.00472607. Epub 2015 Oct 20.

Cohort study on the factors associated with survival post-cardiac arrest

Cássia Regina Vancini-Campanharo  1 , Rodrigo Luiz Vancini  2 , Claudio Andre Barbosa de Lira  3 , Marília dos Santos Andrade  4 , Aécio Flávio Teixeira de Góis  5 , Álvaro Nagib Atallah  5
Affiliations

Cohort study on the factors associated with survival post-cardiac arrest

Cássia Regina Vancini-Campanharo et al. Sao Paulo Med J. 2015 Nov-Dec.

Abstract
in English, Portuguese

Context and objective: Cardiac arrest is a common occurrence, and even with efficient emergency treatment, it is associated with a poor prognosis. Identification of predictors of survival after cardiopulmonary resuscitation may provide important information for the healthcare team and family. The aim of this study was to identify factors associated with the survival of patients treated for cardiac arrest, after a one-year follow-up period.

Design and setting: Prospective cohort study conducted in the emergency department of a Brazilian university hospital.

Methods: The inclusion criterion was that the patients presented cardiac arrest that was treated in the emergency department (n = 285). Data were collected using the In-hospital Utstein Style template. Cox regression was used to determine which variables were associated with the survival rate (with 95% significance level).

Results: After one year, the survival rate was low. Among the patients treated, 39.6% experienced a return of spontaneous circulation; 18.6% survived for 24 hours and of these, 5.6% were discharged and 4.5% were alive after one year of follow-up. Patients with pulseless electrical activity were half as likely to survive as patients with ventricular fibrillation. For patients with asystole, the survival rate was 3.5 times lower than that of patients with pulseless electrical activity.

Conclusions: The initial cardiac rhythm was the best predictor of patient survival. Compared with ventricular fibrillation, pulseless electrical activity was associated with shorter survival times. In turn, compared with pulseless electrical activity, asystole was associated with an even lower survival rate.

CONTEXTO E OBJETIVO:: A parada cardiorrespiratória é comum e, mesmo com tratamentos de emergência eficientes, associa-se a prognósticos ruins. A identificação de fatores preditores de sobrevivência após ressuscitação cardiopulmonar pode fornecer informações importantes para equipe de saúde e familiares. O objetivo deste estudo foi identificar fatores associados à sobrevivência, após um ano de seguimento, de pacientes atendidos em parada cardiorrespiratória.

DESENHO E LOCAL:: Estudo de coorte prospectivo realizado no serviço de emergência de um hospital universitário.

MÉTODOS:: O critério de inclusão foi o atendimento de paciente em parada cardiorrespiratória no serviço de emergência (n = 285). Os dados foram coletados por meio do modelo In-hospital Utstein Style. Para verificar quais variáveis associaram-se à sobrevida, utilizou-se regressão de Cox (nível de significância 95%).

RESULTADOS:: Após um ano, a sobrevida foi baixa. Dos pacientes atendidos, 39,6% tiveram retorno da circulação espontânea, 18,6% sobreviveram até as primeiras 24 horas, sendo que, destes, 5,6% obtiveram alta hospitalar e 4,5% permaneceram vivos após um ano de seguimento. Pacientes com atividade elétrica sem pulso apresentaram duas vezes menos chances de sobreviver que aqueles com fibrilação ventricular. Nos pacientes com assistolia, as taxas de sobrevida foram 3,5 menores quando comparados aos com atividade elétrica sem pulso.

CONCLUSÕES:: O ritmo cardíaco inicial foi o fator preditor que melhor explicou a sobrevida. O ritmo de atividade elétrica sem pulso associou-se a menor sobrevida quando comparado a fibrilação ventricular, enquanto o ritmo de assistolia relacionou-se a ainda menor sobrevivência em relação à atividade elétrica sem pulso.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1. Flowchart of patient follow-up in the study.
Table 1:
Table 1:. Characteristics of the cardiac arrest episodes of the study population.
Table 2:
Table 2:. Factors associated with survival over the first 24 hours after cardiac arrest, at hospital discharge and at six months and one year after discharge.
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