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. 2021 Dec 15:8:764043.
doi: 10.3389/fcvm.2021.764043. eCollection 2021.

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Enrico Baldi  1   2 , Sara Compagnoni  1   3 , Stefano Buratti  4 , Roberto Primi  3 , Sara Bendotti  3 , Alessia Currao  3 , Francesca Romana Gentile  1   3 , Giuseppe Maria Sechi  5 , Claudio Mare  5 , Roberta Bertona  6 , Irene Raimondi Cominesi  7 , Erika Taravelli  8 , Cristian Fava  9 , Gian Battista Danzi  10 , Luigi Oltrona Visconti  3 , Simone Savastano  3 ; all the Lombardia CARe Researchers
Collaborators, Affiliations

Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis

Enrico Baldi et al. Front Cardiovasc Med. .

Abstract

Background: No data are available regarding long-term survival of out-of-hospital cardiac arrest (OHCA) patients based on different Utstein subgroups, which are expected to significantly differ in terms of survival. We aimed to provide the first long-term survival analysis of OHCA patients divided according to Utstein categories. Methods: We analyzed all the 4,924 OHCA cases prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 2015 to 2019. Pre-hospital data, survival, and cerebral performance category score (CPC) at 1, 6, and 12 months and then every year up to 5 years after the event were analyzed for each patient. Results: A decrease in survival was observed during the follow-up in all the Utstein categories. The risk of death of the "all-EMS treated" group exceeded the general population for all the years of follow-up with standardized mortality ratios (SMRs) of 23 (95%CI, 16.8-30.2), 6.8 (95%CI, 3.8-10.7), 3.8 (95%CI, 1.7-6.7), 4.05 (95%CI, 1.9-6.9), and 2.6 (95%CI, 1.03-4.8) from the first to the fifth year of follow-up. The risk of death was higher also for the Utstein categories "shockable bystander witnessed" and "shockable bystander CPR": SMRs of 19.4 (95%CI, 11.3-29.8) and 19.4 (95%CI, 10.8-30.6) for the first year and of 6.8 (95%CI, 6.6-13) and 8.1 (95%CI, 3.1-15.3) for the second one, respectively. Similar results were observed considering the patients discharged with a CPC of 1-2. Conclusions: The mortality of OHCA patients discharged alive from the hospital is higher than the Italian standard population, also considering those with the most favorable OHCA characteristics and those discharged with good neurological outcome. Long-term follow-up should be included in the next Utstein-style revision.

Keywords: Utstein; long-term outcomes; mortality; out of hospital cardiac arrest; survivors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves of the OHCA patients divided into Utstein categories considering all the patients (Left) and only the patients discharged alive from the hospital (Right). The statistical comparison between the curves “shockable bystander witnessed” vs. “non-shockable bystander witnessed” (*) and “shockable bystander CPR” vs. “non-shockable bystander witnessed” (§) is reported.
Figure 2
Figure 2
Kaplan-Meier survival curves of the patients discharged alive with good neurological outcome (CPC ≤ 2) divided into Utstein categories. The statistical comparison between the curves “shockable bystander witnessed” vs. “non-shockable bystander witnessed” (*) and “shockable bystander CPR” vs. “non-shockable bystander witnessed” (§) is reported.
Figure 3
Figure 3
Standardized mortality ratios (SMRs) of the patients discharged alive from the hospital according to Utstein categories.
See this image and copyright information in PMC

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