Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients
Abstract
:1. Introduction
2. Experimental Section
2.1. Setting and Study Population
2.2. TTM Protocol
2.3. Data Collection
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Acknowledgments
Conflicts of Interest
References
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Lown Grade | Definition |
---|---|
0 | No ventricular premature depolarisations |
1 | Less than 30 ventricular extrasystoles per hour |
2 | 30 or more ventricular extrasystoles per hour |
3 | Multiform ventricular extrasystoles |
4A | Two consecutive ventricular extrasystoles |
4B | Three or more consecutive ventricular extrasystoles |
5 | R on T (RV/QT less than 1.0) |
Characteristics | Total (n = 421) | Non-Shockable Re-Arrest (n = 373) | Shockable Re-Arrest (n = 48) | p-Value |
---|---|---|---|---|
Age, years | 55.0 (45.0–65.0) | 55.0 (45.0–64.0) | 59.0 (44.5–68.0) | 0.297 |
Male | 333 (75.0) | 296 (75.1) | 37 (74.0) | 0.960 |
Past medical history | ||||
History of cardiac arrest | 7 (1.7) | 6 (1.6) | 1 (2.1) | 0.574 |
Acute coronary syndrome | 78 (18.5) | 68 (18.2) | 10 (20.8) | 0.662 |
Arrhythmia | 27 (6.4) | 23 (6.2) | 4 (8.3) | 0.532 |
Hypertension | 150 (35.6) | 131 (35.1) | 19 (39.6) | 0.543 |
Diabetes | 82 (19.5) | 74 (19.8) | 8 (16.7) | 0.601 |
Chronic pulmonary disease | 10 (2.4) | 8 (2.1) | 2 (4.2) | 0.319 |
Chronic renal disease | 17 (4.0) | 16 (4.3) | 1 (2.1) | 0.706 |
Liver cirrhosis | 3 (0.7) | 2 (0.5) | 1 (2.1) | 0.305 |
Malignancy | 14 (3.3) | 14 (3.6) | 0 (0.0) | 0.385 |
Vital signs | ||||
Systolic pressure, mmHg | 120.0 (93.3–141.8) | 120.0 (94.0–142.0) | 110.0 (91.0–140.0) | 0.247 |
Diastolic pressure, mmHg | 70.5 (60.0–90.0) | 72.0 (60.0–90.0) | 70.0 (58.0–82.5) | 0.546 |
Pulse rate, beats/min | 100 (80.0–120.0) | 98.0 (80.0–120.0) | 108.5 (81.0–123.0) | 0.401 |
Body temperature, °C | 36.1 (35.5–36.4) | 36.1 (35.5–36.4) | 36.2 (35.5–36.5) | 0.651 |
Laboratory findings, initial | ||||
White blood cell, 103/μL | 13.4 (10.6–18.1) | 13.1 (10.5–17.9) | 14.5 (11.1–21.2) | 0.232 |
Hemoglobin, g/dL | 14.2 (12.4–15.4) | 14.1 (12.2–15.4) | 14.6 (13.1–15.2) | 0.421 |
Sodium, mmol/L | 141.0 (138.0–143.0) | 141.0 (138.0–143.0) | 140.0 (138.0–143.0) | 0.273 |
Potassium, mmol/L | 3.8 (3.4–4.3) | 3.8 (3.4–4.3) | 3.6 (3.2–4.3) | 0.158 |
Calcium, mg/dL | 8.0 (7.4–8.8) | 8.0 (7.4–8.7) | 7.9 (7.4–8.9) | 0.960 |
Magnesium, mg/dL | 2.2 (2.0–2.5) | 2.2 (2.0–2.5) | 2.4 (2.1–2.8) | 0.039 |
Troponin-I, ng/mL | 0.591 (0.120–4.485) | 0.559 (0.114–4.485) | 0.819 (0.141–5.588) | 0.256 |
CK-MB, ng/mL | 7.8 (2.7–30.3) | 7.3 (2.7–26.2) | 12.0 (3.3–53.8) | 0.082 |
BNP, pg/mL | 129.6 (41.0–631.0) | 131.1 (43.0–631.0) | 98.3 (22.4–903.8) | 0.392 |
Witnessed | 350 (83.1) | 311 (83.4) | 39 (81.3) | 0.828 |
Bystander CPR | 251 (59.6) | 221 (59.2) | 30 (62.5) | 0.192 |
Arrest cause | 1.000 | |||
Presume cardiac cause | 386 (91.7) | 342 (91.7) | 44 (91.7) | |
Other medical cause | 35 (8.3) | 31 (8.3) | 4 (8.3) | |
Prehospital initial rhythm | 0.217 | |||
Shockable | 289 (68.6) | 256 (68.6) | 33 (68.8) | |
Non-shockable | 54 (12.8) | 51 (13.7) | 3 (6.3) | |
Unknown | 78 (18.5) | 66 (17.7) | 12 (25.0) | |
Prehospital defibrillation number | 1.0 (0.0–2.0) | 1.0 (0.0–2.0) | 1.0 (0.0–2.0) | 0.426 |
ED defibrillation number | 1.0 (0.0–3.0) | 1.0 (0.0–3.0) | 1.0 (0.0–2.8) | 0.637 |
ED defibrillation energy, Joules | 400 (200–1000) | 400 (200–1000) | 360 (200–690) | 0.739 |
CPR drugs | ||||
Epinephrine | 264 (62.7) | 229 (61.4) | 35 (72.9) | 0.213 |
Vasopressin | 15 (3.6) | 13 (3.5) | 2 (4.2) | 0.694 |
Lidocaine | 16 (3.8) | 13 (3.5) | 3 (6.3) | 0.419 |
Magnesium | 28 (6.7) | 25 (6.7) | 3 (6.3) | 1.000 |
Bicarbonate | 58 (13.8) | 51 (13.7) | 7 (14.6) | 0.950 |
Amiodarone | 109 (25.9) | 93 (24.9) | 16 (33.3) | 0.265 |
ECMO CPR | 15 (3.6) | 13 (3.5) | 2 (4.2) | 1.000 |
No flow time, min | 1.0 (0.0–6.0) | 1.0 (0.0–6.0) | 1.0 (0.0–5.5) | 0.835 |
Low flow time, min | 30.0 (20.0–42.0) | 29.5 (20.0–42.0) | 30.0 (22.0–42.0) | 0.335 |
Survival discharge | 327 (77.7) | 292 (78.3) | 35 (72.9) | 0.401 |
Good neurologic outcome | 224 (53.2) | 198 (53.1) | 26 (54.2) | 0.887 |
Characteristics | Non-Shockable Re-Arrest (n = 373) | Shockable Re-Arrest (n = 48) | p-Value |
---|---|---|---|
Electrocardiography | |||
ST segment elevation | 102 (27.3) | 19 (39.6) | 0.078 |
ST segment depression | 131 (35.1) | 24 (50.0) | 0.044 |
Left bundle branch block | 33 (8.8) | 3 (6.3) | 0.784 |
Right bundle branch block | 40 (10.7) | 7 (14.6) | 0.424 |
Normal ST and T wave | 88 (23.6) | 5 (10.4) | 0.038 |
Prolonged QTc interval | 230 (61.7) | 32 (66.7) | 0.501 |
Ventricular premature complex | 43 (11.5) | 14 (29.2) | 0.001 |
Coronary artery angiography | |||
Interval of ROSC to CAG, hours | 4.0 (2.0–101.5) | 4.0 (2.0–66.0) | 0.548 |
Left anterior descending stenosis | 119 (41.3) | 14 (36.8) | 0.598 |
Right coronary artery stenosis | 101 (34.5) | 9 (23.7) | 0.184 |
Left circumflex artery stenosis | 95 (33.0) | 8 (21.1) | 0.137 |
Percutaneous coronary intervention | 96 (25.7) | 13 (27.1) | 0.841 |
Prophylactic amiodarone infusion | 97 (26.0) | 20 (41.7) | 0.023 |
Cardiovascular drugs during TTM | |||
Dopamine | 230 (62.0) | 38 (79.2) | 0.020 |
Norepinephrine | 201 (54.2) | 35 (72.9) | 0.014 |
Vasopressin | 29 (7.8) | 4 (8.3) | 0.781 |
Epinephrine | 24 (6.5) | 7 (14.6) | 0.071 |
Dobutamine | 49 (13.2) | 9 (18.8) | 0.299 |
Risk Factors of Shockable Re-Arrest | Non-Shockable Re-Arrest (n = 373) | Shockable Re-Arrest (n = 48) | Univariate Analysis OR (95% CI) | p-Value | Multivariate Analysis OR (95% CI) | p-Value |
---|---|---|---|---|---|---|
Electrocardiography | ||||||
ST segment elevation | 102 (27.3) | 19 (39.6) | OR 1.74 (95% CI 0.94–3.24) | 0.081 | OR 1.278 (95% CI 0.624–2.616) | 0.502 |
ST segment depression | 131 (35.1) | 24 (50.0) | OR 1.85 (95% CI 1.01–3.38) | 0.047 | OR 1.320 (95% CI 0.642–2.717) | 0.450 |
Normal ST and T wave | 88 (23.6) | 5 (10.4) | OR 0.38 (95% CI 0.15–0.98) | 0.045 | OR 0.513 (95% CI 0.172–1.533) | 0.232 |
Ventricular premature complex | 43 (11.5) | 14 (29.2) | OR 3.16 (95% CI 1.57–6.36) | 0.001 | OR 2.806 (95% CI 1.276–6.171) | 0.010 |
Laboratory findings, initial | ||||||
CK-MB, ng/mL | 7.3 (2.7–26.2) | 12.0 (3.3–53.8) | OR 1.00 (95% CI 1.00–1.01) | 0.041 | OR 1.001 (95% CI 0.999–1.004) | 0.389 |
Magnesium, mg/dL | 2.2 (2.0–2.5) | 2.2 (2.0–2.5) | OR 1.20 (95% CI 0.82–1.75) | 0.344 | OR 1.028 (95% CI 0.659–1.605) | 0.903 |
Prophylactic amiodarone infusion | 97 (26.0) | 20 (41.7) | OR 2.03 (95% CI 1.10–3.77) | 0.025 | OR 1.533 (95% CI 0.771–3.050) | 0.223 |
Cardiovascular drugs during TTM | ||||||
Dopamine | 230 (62.0) | 38 (79.2) | OR 2.33 (95% CI 1.13–4.82) | 0.023 | OR 2.172 (95% CI 0.894–5.274) | 0.087 |
Norepinephrine | 201 (54.2) | 35 (72.9) | OR 2.27 (95% CI 1.17–4.44) | 0.016 | OR 1.304 (95% CI 0.606–2.807) | 0.497 |
Epinephrine | 24 (6.5) | 7 (14.6) | OR 2.46 (95% CI 1.00–6.07) | 0.050 | OR 2.828 (95% CI 0.954–8.377) | 0.061 |
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Ryoo, S.M.; Lee, D.H.; Lee, B.K.; Youn, C.S.; Kim, Y.-J.; Kim, S.J.; Kim, Y.H.; Kim, W.Y. Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients. J. Clin. Med. 2019, 8, 1360. https://doi.org/10.3390/jcm8091360
Ryoo SM, Lee DH, Lee BK, Youn CS, Kim Y-J, Kim SJ, Kim YH, Kim WY. Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients. Journal of Clinical Medicine. 2019; 8(9):1360. https://doi.org/10.3390/jcm8091360
Chicago/Turabian StyleRyoo, Seung Mok, Dong Hun Lee, Byung Kook Lee, Chun Song Youn, Youn-Jung Kim, Su Jin Kim, Yong Hwan Kim, and Won Young Kim. 2019. "Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients" Journal of Clinical Medicine 8, no. 9: 1360. https://doi.org/10.3390/jcm8091360