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Predictors of good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest patients undergoing therapeutic hypothermia

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Abstract

Neurologically intact survival after cardiac arrest is possible even after prolonged resuscitation efforts. However, the factors associated with good neurologic outcome in these patients remain unknown. This study identifies predictors associated with good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). This multicenter, registry-based, retrospective cohort study conducted in 24 hospitals across South Korea between 2007 and 2012 includes adult (≥18 years) non-traumatic OHCA patients with prolonged (>30 min) downtime who underwent TTM treatment. Good neurologic outcomes were defined as cerebral performance category scores of ≤2. Of the 930 comatose adult cardiac arrest patients treated with TTM, 423 patients with prolonged downtime were included. A total of 76 (18.0%) had good neurologic outcome. Multivariable analysis reveal that age <65 years (OR 7.91, 95% CI 3.18–19.68), initial shockable rhythm (OR 6.31, 95% CI 3.40–11.74), and witnessed arrest (OR 3.81, 95% CI 1.73–8.45) are associated with good neurologic outcome. The sensitivity and specificity for good neurologic outcome in patients with age <65 years, shockable rhythm, and witnessed arrest are 90.8% and 41.2, 67.6 and 79.5%, and 81.6 and 41.2%, respectively. In prolonged cardiac arrest patients, initial shockable rhythm, age <65 years, or witnessed arrest are predictors for neurologic intact survival.

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Acknowledgements

We appreciate the help of all of the site investigators and clinical research coordinators in the participating hospitals of the Korean Hypothermia Network; Kyu Nam Park1, Gu Hyun Kang2, Kyung Hwan Kim3, Giwoon Kim4, Jin Hong Min5, Yooseok Park6, Jung Bae Park7, Yoo Dong Son8, Jonghwan Shin9, Joo Suk Oh2, Yeon Ho You10, Dong Hoon Lee11, Jong Seok Lee12, Hoon Lim13, Tae Chang Jang14, Gyu Chong Cho15, In Soo Cho16, Kyoung Chul Cha17, Wook Jin Choi18, Chul Han19; Department of Emergency Medicine, 1The Catholic University of Korea College of Medicine, Seoul; 2Hallym University Kangnam Sacred Heart Hospital, Seoul; 3Inje University Ilsan Paik Hospital, Goyang; 4Ajou University Hospital, Suwon; 5Chungbuk National University College of Medicine, Cheongju; 6Yonsei University College of Medicine, Seoul; 7Kyungpook National University School of Medicine, Daegu; 8Hallym University Sacred Heart Hospital, Anyang; 9Seoul National University Boramae Medical Center, Seoul; 10Chungnam National University School of Medicine, Daejeon; 11Chung-Ang University College of Medicine, Seoul; 12Kyung Hee University School of Medicine, Seoul; 13Soonchunhyang University College of Medicine, Bucheon; 14Catholic University of Daegu School of Medicine, Daegu; 15Hallym University Kangdong Sacred Heart Hospital, Seoul; 16Hanil General Hospital, Korea Electric Power Medical Corporation, Seoul; 17Yonsei University Wonju College of Medicine, Wonju; 18Ulsan University College of Medicine, Ulsan; 19Ewha Womans School of Medicine, Seoul, Korea.

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  1. Shin Ahn and Byung Kook Lee authors contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea

    Shin Ahn, Youn-Jung Kim, Chang Hwan Sohn, Dong-Woo Seo & Won Young Kim

  2. Department of Emergency Medicine, College of Medicine, Chonnam National University, Gwangju, Korea

    Byung Kook Lee

  3. Department of Emergency Medicine, College of Medicine, Seoul Saint Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

    Chun Song Youn

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  1. Shin Ahn
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Correspondence to Won Young Kim.

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Ahn, S., Lee, B.K., Youn, C. et al. Predictors of good neurologic outcome after resuscitation beyond 30 min in out-of-hospital cardiac arrest patients undergoing therapeutic hypothermia. Intern Emerg Med 13, 413–419 (2018). https://doi.org/10.1007/s11739-017-1662-4

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