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. 2022 Mar 29;38(3):416-424.
doi: 10.1002/joa3.12705. eCollection 2022 Jun.

Clinicopathological correlates of out-of-hospital cardiac arrests

Tony Li  1 , Jonathan Yap  2   3 , Wei Qiang Chng  1 , Julian Cheong Kiat Tay  2 , Nur Shahidah  4 , Colin Yeo  5 , Han Nee Gan  6 , Khim Leng Tong  5 , Yih Yng Ng  7 , Jia Hao Wu  8 , Marian Wang  8 , Marcus Eng Hock Ong  3   4 , Chi Keong Ching  2   3
Affiliations

Clinicopathological correlates of out-of-hospital cardiac arrests

Tony Li et al. J Arrhythm. .

Abstract

Background: Sudden cardiac arrest with or without sudden cardiac death (SCD) represents a heterogeneous spectrum of underlying etiology but is often a catastrophic event. Despite improvements in pre-hospital response and post-resuscitation care, outcomes remain grim. Thus, we aim to evaluate the predictors of survival in out-of-hospital cardiac arrests (OHCAs) and describe autopsy findings of those with the uncertain cause of death (COD).

Methods: This is a subgroup analysis of the Singapore cohort from the Pan Asian Resuscitation Outcome Study which studied 933 OHCAs admitted to two Singapore tertiary hospitals from April 2010 to May 2012.

Results: Of the patients analysed, 30.2% (n = 282) had an initial return of spontaneous circulation (ROSC) at the emergency department, 18.0% (n = 168) had sustained ROSC with subsequent admission and 3.4% (n = 32) had survival to discharge. On multivariate analysis, an initial shockable rhythm, a witnessed event, prehospital defibrillation, and shorter time to hospital predicted ROSC as well as survival to discharge. A total of 163 (17.5%) autopsies were performed of which a cardiac etiology of SCD was noted in 92.1% (n = 151). Ischemic heart disease accounted for 54.3% (n = 89) of the autopsy cohort, with acute myocardial infarction (26.9%, n = 44) and myocarditis (3.7%, n = 6) rounding out the top three causes of demise.

Conclusion: OHCA remains a clinical presentation that portends a poor prognosis. Of those with uncertain COD, cardiac etiology appears to predominate from autopsy study. Identification of prognostic factors will play an important role in improving individual-level and systemic-level variables to further optimize outcomes.

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Conflict of interest statement

MEH Ong reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan‐Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR Training Centre Research Program in Norway. MEH Ong has a licensing agreement and a patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient.” All other authors have no conflict of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Degree of coronary artery disease based on autopsy findings
See this image and copyright information in PMC

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