Abstract
Purpose
Sudden cardiac death (SCD) is a major public health concern, but data regarding epidemiology of this disease in Western European countries are outdated. This study reports the first results from a large registry of SCD.
Methods
A population-based registry was established in May 2011 using multiple sources to collect every case of SCD in Paris and its suburbs, covering a population of 6.6 million. Utstein variables were recorded. Pre-hospital and in-hospital data were considered, and the main outcome was survival at hospital discharge. Neurologic status at discharge was established as well.
Results
Of the 6,165 cases of SCD recorded over 2 years, 3,816 had a resuscitation attempt and represent the study population. Most patients were male (69 %), the SCD occurred at home (72 %) with bystanders in 80 % of cases, and cardiopulmonary resuscitation (CPR) was performed in 45 % of cases. Initial rhythm was shockable in 26 % of cases. A total of 1,332 patients (35 %) were admitted alive to hospital. Among hospitalized patients, 58 % had a coronary angiogram, and the same proportion had therapeutic hypothermia. Finally, 279 patients (7.5 %) were discharged alive, of whom 96 % had a favorable neurological outcome. In multivariate analysis, bystander CPR (OR 2.1, 95 % CI 1.5–3.1) and initial shockable rhythm (OR 11.5, 95 % CI 7.6–17.3) were positively associated with survival at hospital discharge, whereas age (OR 0.97 per year, 95 % CI 0.96–0.98), longer response time (OR 0.93 per minute, 95 % CI 0.89–0.97), occurrence at home (OR 0.4, 95 % CI 0.3–0.6), and epinephrine dose greater than 3 mg (OR 0.05, 95 % CI 0.03–0.08) were inversely associated with survival.
Conclusion
Despite being conducted in the therapeutic hypothermia and early coronary angiogram era, hospital discharge survival rate of resuscitated SCD remains poor. The current registry suggests ways to improve pre-hospital and in-hospital care of these patients.
Similar content being viewed by others
References
Sasson C, Rogers MAM, Dahl J, Kellermann AL (2010) Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 3(1):63–81
Ornato JP, Becker LB, Weisfeldt ML, Wright BA (2010) Cardiac arrest and resuscitation: an opportunity to align research prioritization and public health need. Circulation 122(18):1876–1879
Adnet F, Lapostolle F (2004) International EMS systems: France. Resuscitation 63(1):7–9
Stiell IG, Wells GA, Field B et al (2004) Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 351(7):647–656
Spaulding CM, Joly LM, Rosenberg A et al (1997) Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 336(23):1629–1633
Dumas F, Cariou A, Manzo-Silberman S et al (2010) Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: clinical perspective insights from the PROCAT (Parisian region out of hospital cardiac arrest) registry. Circ Cardiovasc Interv 3(3):200–207
Bernard SA, Gray TW, Buist MD et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346(8):557–563
Hypothermia after Cardiac Arrest Study group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346(8):549–556
Nielsen N, Wetterslev J, Cronberg T et al (2013) Targeted temperature management at 33 versus 36 °C after cardiac arrest. N Engl J Med 369(23):2197–2206
Deakin CD, Nolan JP, Soar J et al (2010) European Resuscitation Council guidelines for resuscitation 2010 section 4. Adult advanced life support. Resuscitation 81(10):1305–1352
Orban J-C, Cattet F, Lefrant J-Y et al (2012) The practice of therapeutic hypothermia after cardiac arrest in France: a national survey. PLoS One 7(9):e45284
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335(7624):806–808
Gueugniaud P-Y, David J-S, Chanzy E et al (2008) Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 359(1):21–30
Fishman GI, Chugh SS, Dimarco JP et al (2010) Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop. Circulation 122(22):2335–2348
Jacobs I, Nadkarni V, Bahr J et al (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 110(21):3385–3397
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1(7905):480–484
Zipes DP, Camm AJ, Borggrefe M et al (2006) ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114(10):e385–e484
Mahapatra S, Bunch TJ, White RD, Hodge DO, Packer DL (2005) Sex differences in outcome after ventricular fibrillation in out-of-hospital cardiac arrest. Resuscitation 65(2):197–202
Jost D, Degrange H, Verret C et al (2010) DEFI 2005: a randomized controlled trial of the effect of automated external defibrillator cardiopulmonary resuscitation protocol on outcome from out-of-hospital cardiac arrest. Circulation 121(14):1614–1622
Margey R, Browne L, Murphy E et al (2011) The Dublin cardiac arrest registry: temporal improvement in survival from out-of-hospital cardiac arrest reflects improved pre-hospital emergency care. Europace 13(8):1157–1165
McNally B, Robb R, Mehta M et al (2011) Out-of-hospital cardiac arrest surveillance—cardiac arrest registry to enhance survival (CARES), United States, October 1, 2005–December 31, 2010. MMWR Surveill Summ 60(8):1–19
Morrison LJ, Visentin LM, Kiss A et al (2006) Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med 355(5):478–487
Marijon E, Bougouin W, Celermajer DS et al (2013) Major regional disparities in outcomes after sudden cardiac arrest during sports. Eur Heart J 34(47):3632–3640
Gräsner J-T, Meybohm P, Lefering R et al (2011) ROSC after cardiac arrest–the RACA score to predict outcome after out-of-hospital cardiac arrest. Eur Heart J 32(13):1649–1656
Dumas F, Rea TD, Fahrenbruch C et al (2013) Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation. Circulation 127(4):435–441
Weisfeldt ML, Everson-Stewart S, Sitlani C et al (2011) Ventricular tachyarrhythmias after cardiac arrest in public versus at home. N Engl J Med 364(4):313–321
Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK (2002) Changing incidence of out-of-hospital ventricular fibrillation, 1980-2000. J Am Med Assoc 288(23):3008–3013
Bunch TJ, White RD (2005) Trends in treated ventricular fibrillation in out-of-hospital cardiac arrest: ischemic compared to non-ischemic heart disease. Resuscitation 67(1):51–54
Larsen JM, Ravkilde J (2012) Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest–a systematic review and meta-analysis. Resuscitation 83(12):1427–1433
Sideris G, Voicu S, Dillinger JG et al (2011) Value of post-resuscitation electrocardiogram in the diagnosis of acute myocardial infarction in out-of-hospital cardiac arrest patients. Resuscitation 82(9):1148–1153
Dumas F, Grimaldi D, Zuber B et al (2011) Is hypothermia after cardiac arrest effective in both shockable and nonshockable patients? Insights from a large registry. Circulation 123(8):877–886
Kim F, Nichol G, Maynard C et al (2014) Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. J Am Med Assoc 311(1):45–52
Giraud F, Rascle C, Guignand M (1996) Out-of-hospital cardiac arrest. Evaluation of 1 year of activity in Saint-Etienne’s emergency medical system using the Utstein style. Resuscitation 33(1):19–27
Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30(11):2126–2128
Vaahersalo J, Hiltunen P, Tiainen M et al (2013) Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Med 39(5):826–837
Deye N, Arrich J, Cariou A (2013) To cool or not to cool non-shockable cardiac arrest patients: it is time for randomized controlled trials. Intensive Care Med 39(5):966–969
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Take-home message: Despite being conducted in the therapeutic hypothermia and early coronary angiogram era, hospital discharge survival rate of resuscitated SCD remains poor. The current registry further suggests that increasing bystander CPR, therapeutic hypothermia, and early coronary angiogram coverage may improve short-term prognosis.
On behalf of the Paris—Sudden Death Expertise Center (SDEC)
The SDEC Co-investigators are listed in the Appendix.
A. Cariou and X. Jouven contributed equally.
W. Bougouin and L. Lamhaut contributed equally.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Appendix: SDEC Co-investigators
Appendix: SDEC Co-investigators
J.M. Agostinucci, D. Annane, F. Beganton, W. Bougouin, R. Cador, A. Cariou, P. Carli, C. Cerf, A. Chaib, G. Chironi, B. Clero, Y. Cohen, A. Combes, J.M. Coulaud, V. Das, N. Deye, J.L. Diehl, D. Dreyfuss, O. Dubourg, A. Duguet, F. Dumas, J. Duranteau, F. Fraisse, P. Henry, F. Hidden Lucet, L. Jacob, D. Jost, D. Journois, X. Jouven, L. Lamhaut, V. Lanoe, A. Leenhardt, N. Lellouche, V. Lemiale, T. Loeb, E. Marijon, A. Mekontso-Dessap, B. Misset, X. Monnet, N. Mongardon, B. Mourvillier, M.C. Perier, O. Piot, M. Raux, F. Revaux, B. Riou, F. Santoli, C. Spaulding, O. Varenne, A. Vieillard Baron.
Rights and permissions
About this article
Cite this article
Bougouin, W., Lamhaut, L., Marijon, E. et al. Characteristics and prognosis of sudden cardiac death in Greater Paris. Intensive Care Med 40, 846–854 (2014). https://doi.org/10.1007/s00134-014-3252-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-014-3252-5