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. 2018 Sep:130:33-40.
doi: 10.1016/j.resuscitation.2018.06.024. Epub 2018 Jun 22.

Arrest etiology among patients resuscitated from cardiac arrest

Niel Chen  1 , Clifton W Callaway  2 , Francis X Guyette  2 , Jon C Rittenberger  2 , Ankur A Doshi  2 , Cameron Dezfulian  3 , Jonathan Elmer  4 ; Pittsburgh Post-Cardiac Arrest Service
Affiliations

Arrest etiology among patients resuscitated from cardiac arrest

Niel Chen et al. Resuscitation. 2018 Sep.

Abstract

Introduction: Cardiac arrest etiology is often assigned according to the Utstein template, which differentiates medical (formerly "presumed cardiac") from other causes. These categories are poorly defined, contain within them many clinically distinct etiologies, and are rarely based on diagnostic testing. Optimal clinical care and research require more rigorous characterization of arrest etiology.

Methods: We developed a novel system to classify arrest etiology using a structured chart review of consecutive patients treated at a single center after in- or out-of-hospital cardiac arrest over four years. Two reviewers independently reviewed a random subset of 20% of cases to calculate inter-rater reliability. We used X2 and Kruskal-Wallis tests to compare baseline clinical characteristics and outcomes across etiologies.

Results: We identified 14 principal arrest etiologies, and developed objective diagnostic criteria for each. Inter-rater reliability was high (kappa = 0.80). Median age of 986 included patients was 60 years, 43% were female and 71% arrested out-of-hospital. The most common etiology was respiratory failure (148 (15%)). A minority (255 (26%)) arrested due to cardiac causes. Only nine (1%) underwent a diagnostic workup that was unrevealing of etiology. Rates of awakening and survival to hospital discharge both differed across arrest etiologies, with survival ranging from 6% to 60% (both P < 0.001), and rates of favorable outcome ranging from 0% to 40% (P < 0.001). Timing and mechanism of death (e.g. multisystem organ failure or brain death) also differed significantly across etiologies.

Conclusions: Arrest etiology was identifiable in the majority cases via systematic chart review. "Cardiac" etiologies may be less common than previously thought. Substantial clinical heterogeneity exists across etiologies, suggesting previous classification systems may be insufficient.

Keywords: Cardiac arrest; Epidemiology; Etiology; Outcomes; Post-arrest.

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Figures

Figure 1:
Figure 1:
Cardiac arrest etiologies, stratified by etiologies likely to be considered “presumed cardiac” under the classic Utstein template; non-cardiac etiologies; and other unclassified, multiple and unknown etiologies.
Figure 2:
Figure 2:
Flowchart for determination of cardiac arrest etiology
See this image and copyright information in PMC

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References

    1. Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, Deakin CD, Finn JC, Grasner JT, Hazinski MF, Iwami T, Koster RW, Lim SH, Huei-Ming Ma M, McNally BF, Morley PT, Morrison LJ, Monsieurs KG, Montgomery W, Nichol G, Okada K, Eng Hock Ong M, Travers AH, Nolan JP, Utstein C, (2015) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation 132: 1286–1300 - PubMed
    1. Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, Bossaert L, Delooz HH, Dick WF, Eisenberg MS, et al., (1991) Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 84: 960–975 - PubMed
    1. Rittenberger JC, Guyette FX, Tisherman SA, DeVita MA, Alvarez RJ, Callaway CW, (2008) Outcomes of a hospital-wide plan to improve care of comatose survivors of cardiac arrest. Resuscitation 79: 198–204 - PMC - PubMed
    1. Elmer J, Rittenberger JC, Coppler PJ, Guyette FX, Doshi AA, Callaway CW, Pittsburgh Post-Cardiac Arrest S, (2016) Long-term survival benefit from treatment at a specialty center after cardiac arrest. Resuscitation 108: 48–53 - PMC - PubMed
    1. Coppler PJ, Elmer J, Calderon L, Sabedra A, Doshi AA, Callaway CW, Rittenberger JC, Dezfulian C, the Post Cardiac Arrest S, (2015) Validation of the Pittsburgh Cardiac Arrest Category illness severity score. Resuscitation - PMC - PubMed

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