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Multicenter Study
. 2021 May 18;77(19):2353-2362.
doi: 10.1016/j.jacc.2021.03.299.

Factors Predisposing to Survival After Resuscitation for Sudden Cardiac Arrest

Santo Ricceri  1 , James W Salazar  2 , Andrew A Vu  3 , Eric Vittinghoff  4 , Ellen Moffatt  5 , Zian H Tseng  6
Affiliations
Multicenter Study

Factors Predisposing to Survival After Resuscitation for Sudden Cardiac Arrest

Santo Ricceri et al. J Am Coll Cardiol. .

Abstract

Background: In the POST SCD study, the authors autopsied all World Health Organization (WHO)-defined sudden cardiac deaths (SCDs) and found that only 56% had an arrhythmic cause; resuscitated sudden cardiac arrests (SCAs) were excluded because they did not die suddenly. They hypothesized that causes underlying resuscitated SCAs would be similarly heterogeneous.

Objectives: The aim of this study was to determine the causes and outcomes of resuscitated SCAs.

Methods: The authors identified all out-of-hospital cardiac arrests (OHCAs) from February 1, 2011, to January 1, 2015, of patients aged 18 to 90 years in San Francisco County. Resuscitated SCAs were OHCAs surviving to hospitalization and meeting WHO criteria for suddenness. Underlying cause was determined by comprehensive record review.

Results: The authors identified 734 OHCAs over 48 months; 239 met SCA criteria, 133 (55.6%) were resuscitated to hospitalization, and 47 (19.7%) survived to discharge. Arrhythmic causes accounted for significantly more resuscitated SCAs overall (92 of 133, 69.1%), particularly among survivors (43 of 47, 91.5%), than WHO-defined SCDs in POST SCD (293 of 525, 55.8%; p < 0.004 for both). Among resuscitated SCAs, arrhythmic cause, ventricular tachycardia/fibrillation initial rhythm, and white race were independent predictors of survival. None of the resuscitated SCAs due to neurologic causes survived.

Conclusions: In this 4-year countywide study of OHCAs, only one-third were sudden, of which one-half were resuscitated to hospitalization and 1 in 5 survived to discharge. Arrhythmic cause predicted survival and nearly one-half of nonsurvivors had nonarrhythmic causes, suggesting that SCA survivors are not equivalent to SCDs. Early identification of nonarrhythmic SCAs, such as neurologic emergencies, may be a target to improve OHCA survival.

Keywords: out of hospital cardiac arrest; resuscitation; sudden cardiac death.

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Conflict of interest statement

Funding Support and Author Disclosures This study was funded by the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) (R01 HL102090 to Dr. Tseng). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Dr. Tseng has received grants from NIH/NHLBI and the Centers for Disease Control and Prevention during the conduct of the study, and personal fees from Biotronik outside the submitted work. Dr. Salazar has received a grant (R38HL143581) from the NHLBI. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Identification of Resuscitated Sudden Cardiac Arrests.
SCAs aged 18–90 resuscitated to hospitalization in San Francisco County, CA were identified from 2/1/2011 to 1/1/2015. OHCAs dying in the field/ED were excluded but analyzed in the POST SCD Study. Non-sudden OHCAs were excluded. Of the 734 OHCAs analyzed, 133 met SCA criteria and were resuscitated to hospitalization (resuscitated SCAs), of which 86 died during hospitalization and 47 survived to hospital discharge. *Cases included in the POST SCD Study, but do not reflect the entirety of POST SCD cases because additional unwitnessed cases meeting WHO definition were included in the POST SCD protocol. † Unidentifiable cases (e.g., “John Doe”). ‡ Non-Sudden (n=107): end stage disease (n=53), skilled nursing facility (n=23), hospice (n=10), do not resuscitate (DNR) status (n=10), recent serious diagnosis (n=11). Not unexpected (n=108): symptoms > 1hr (n= 63), or suicide/trauma/overdose (n=45). OOH = Out of hospital, OHCA = Out of hospital cardiac arrest, POST SCD = POstmortem Systematic InvesTigation of Sudden Cardiac Death (POST SCD) Study, SCA = Sudden cardiac arrest.
Figure 2.
Figure 2.. Adjudicated Causes of Resuscitated SCAs.
Etiologies of resuscitated SCAs as determined by review of EMS runsheets and hospitalization records after admission for resuscitated SCA. Causes of arrest were classified as arrhythmic (red), cardiac-nonarrhythmic (blue), and non-cardiac (green). CAD=Coronary Artery Disease. Central Illustration. Underlying Causes of SCA By Resuscitation and Survival Status. All OHCAs between 2/1/2011 and 1/1/2015 in San Francisco County, CA were identified through EMS agencies. OHCAs dying in the field/ED (POST SCD cases) or non-sudden were excluded, to arrive at SCAs resuscitated to hospitalization. Causes of resuscitated SCA were determined after review of comprehensive hospital records: arrhythmic (red), cardiac/non-arrhythmic (blue), or non-cardiac causes (green). Arrhythmic causes accounted for 69.1% (92 of 133) of resuscitated SCAs, significantly higher than the 55.8% of SCAs resulting in WHO-defined (presumed) SCDs by autopsy as reported in POST SCD (P=0.004). Arrhythmic cause was significantly more common in survivors than non-survivors (92% vs. 57%, P< 0.001). * N=525 total presumed SCDs as previously reported,9 including 334 OHCAs identified in this study with initial signs of life but dying on scene/ED and an additional 191 EMS-attended cases in POST SCD without signs of life but with primary impression OHCA. † P-value survivors vs. non-survivors.
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Comment in

  • The Shadows of Sudden Cardiac Death.
    Stecker EC, Nazer B. Stecker EC, et al. J Am Coll Cardiol. 2021 May 18;77(19):2363-2365. doi: 10.1016/j.jacc.2021.03.321. J Am Coll Cardiol. 2021. PMID: 33985680 No abstract available.
  • Sudden Death: Thinking Beyond the Heart.
    Keen SK, Simpson RJ Jr. Keen SK, et al. J Am Coll Cardiol. 2021 Sep 7;78(10):e61. doi: 10.1016/j.jacc.2021.06.046. J Am Coll Cardiol. 2021. PMID: 34474742 No abstract available.
  • Reply: Sudden Death: Thinking Beyond the Heart.
    Tseng ZH, Ricceri S, Salazar JW. Tseng ZH, et al. J Am Coll Cardiol. 2021 Sep 7;78(10):e63. doi: 10.1016/j.jacc.2021.07.007. J Am Coll Cardiol. 2021. PMID: 34474743 No abstract available.

References

    1. Sasson C, Rogers MAM., Dahl J, Kellermann AL. Predictors of Survival From Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes. 2010;3(1):63–81. doi:10.1161/CIRCOUTCOMES.109.889576 - DOI - PubMed
    1. Chugh SS, Jui J, Gunson K, et al. Current burden of sudden cardiac death: Multiple source surveillance versus retrospective death certificate-based review in a large U.S. community. J Am Coll Cardiol. 2004;44(6):1268–1275. doi:10.1016/j.jacc.2004.06.029 - DOI - PubMed
    1. Nichol G, Rumsfeld J, Eigel B, et al. Essential Features of Designating Out-of-Hospital Cardiac Arrest as a Reportable Event. Circulation. 2008;117(17):2299–2308. doi:10.1161/CIRCULATIONAHA.107.189472 - DOI - PubMed
    1. Narayan SM., Wang PJ., Daubert JP. New Concepts in Sudden Cardiac Arrest to Address an Intractable Epidemic. J Am Coll Cardiol. 2019;73(1):70–88. doi:10.1016/j.jacc.2018.09.083 - DOI - PMC - PubMed
    1. McNally B, Stokes A, Crouch A, Kellermann AL. CARES: Cardiac Arrest Registry to Enhance Survival. Ann Emerg Med. 2009;54(5):674–683.e2. doi:10.1016/j.annemergmed.2009.03.018 - DOI - PubMed

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