Factors associated with re-arrest following initial resuscitation from cardiac arrest

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• 作者：Abhishek Bhardwaj^a ; ^f ; ¹ ; Daniel J. Ikeda^a ; ¹ ; Anne V. Grossestreuer^a ; ^b ; ^c ; ^d ; Kelsey R. Sheak^a ; Gail Delfin^a ; Timothy Layden^a ; Benjamin S. Abella^a ; Marion Leary^a ; ^e ; ^{marion.leary@uphs.upenn.edu}
• 关键词：Epidemiology ; Critical care outcomes ; Heart arrest ; Cardiopulmonary resuscitation ; Risk factors ; Advanced cardiac life support
• 刊名：Resuscitation
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：111
• 期：Complete
• 页码：90-95
• 全文大小：934 K
• 卷排序：111

文摘

To examine patient- and arrest-level factors associated with the incidence of re-arrest in the hospital setting, and to measure the association between re-arrest and survival to discharge.MethodsThis work represents a retrospective cohort study of adult patients who were successfully resuscitated from an initial out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (ICHA) of non-traumatic origin at two urban academic medical centers. In this study, re-arrest was defined as loss of a pulse following 20 min of sustained return of spontaneous circulation (ROSC).ResultsBetween 01/2005 and 04/2016, 1961 patients achieved ROSC following non-traumatic cardiac arrest. Of those, 471 (24%) experienced at least one re-arrest. In re-arrest patients, the median time from initial ROSC to first re-arrest was 5.4 h (IQR: 1.1, 61.8). The distribution of initial rhythms between single- and re-arrest patients did not vary, nor did the median duration of initial arrest. Among 108 re-arrest patients with an initial shockable rhythm, 60 (56%) experienced a shockable re-arrest rhythm. Among 273 with an initial nonshockable rhythm, 31 (11%) experienced a shockable re-arrest rhythm. After adjusting for significant covariates, the incidence of re-arrest was associated with a lower likelihood of survival to discharge (OR: 0.32; 95% CI: 0.24–0.43; p < 0.001).ConclusionsRe-arrest is a common complication experienced by cardiac arrest patients that achieve ROSC, and occurs early in the course of their post-arrest care. Moreover, re-arrest is associated with a decreased likelihood of survival to discharge, even after adjustments for relevant covariates.