Survival rates with favorable neurological outcomes after in-hospital and out-of-hospital cardiac arrest: A prospective cohort study

Abstract

Objectives: To evaluate the survival rates with favorable neurological outcomes among patients who experienced in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA).

Design: This prospective cohort study assessed 554 adult patients with IHCA or OHCA referred to Hamad General Hospital, Qatar, between February 2015 and November 2021. Neurologic outcomes were measured using the Cerebral Performance Category (CPC) score. Survival rate and neurologic status were re-evaluated at 28 days, hospital discharge, and one year after cardiac arrest (CA).

Findings: For all participants, the hospital discharge and one-year survival rates with a favorable neurological outcome (CPC ≤ 2) were 18.5 % and 19.5 %, respectively. Specifically, among patients with IHCA, the rates were 20.5 % and 19 %, while in patients with OHCA, the rates were 16.4 % and 19.9 %, respectively. Multivariate regression analysis indicated that factors male sex (OR: 2.129, 95 % CI: 1.168-3.881, P = 0.014), initial shockable rhythm (OR: 1.691, 95 % CI: 1.024-2.788, P = 0.041), and the use of ECPR (OR: 1.944, 95 % CI: 1.178-3.209, P = 0.009) were associated with increased likelihood of survival with favorable neurological outcomes at 28 days. Conversely, older age, presence of comorbidities, infection, higher APACHE II score, longer hospital stays, and undergoing tracheostomy were linked to decreased chances of survival with favorable neurological outcomes at different time points.

Conclusion: Survival with good neurological outcomes after OHCA was 20.3 %, 16.4 %, and 19.9 % at 28 days, hospital discharge, and one year, respectively. Among patients with IHCA, survival with good neurological outcomes was 20.5 %, 20.5 %, and 19 % at 28 days, hospital discharge, and one year, respectively.

Implications for clinical practice: Care of CA patients in a cardiac arrest center is associated with improved long-term survival with favorable neurological outcomes. Prioritizing early intervention for shockable rhythms and utilizing ECPR where appropriate could enhance patient prognosis.

Keywords: Cardiac arrest; Cerebral performance category; Extracorporeal cardiopulmonary resuscitation (ECPR); In-hospital cardiac arrest; Neurological outcomes; Out-of-hospital cardiac arrest; Survival rate.