Abstract 231: Predicting Outcome After Out-of-Hospital Cardiac Arrest: Results of a National Registry
Background: Advanced post-resuscitation
care including mild therapeutic hypothermia reduces mortality and improves neurological outcome after OHCA. The aim of the current registry is to identify clinical parameters in OHCA patients treated with a modern post-resuscitation care in order to identify predictors of survival and neurological recovery.
Methods and Results: Data sets of 881 OHCA patients treated between 2002-2011 in 4 German university hospitals were analyzed retrospectively. ICU mortality was 36.5% increasing to 45.6% and 53.9% after 1 and 6 months, respectively. Several factors, such as age, initial rhythm, duration of no-flow phase and others were identified as predictive factors for 6 months mortality but not for a survival with good neurological outcome. Interestingly,temperature between hours 8 and 36 after start of cooling were lower in long-term survivors as compared to those who died (Fig A). There was no effect of cooling velocity, duration of cooling and re-warming velocity neither on survival nor neurological recovery after 6 months . In 497 patients neuron specific enolase (NSE) was measured. NSE levels between day 1 and 3 significantly predicted survival (Fig B) and a cut-off of 80µg/L was identified for a markedly increased mortality.
Conclusions: Even after implementation of an improved post resuscitation care, mortality after cardiac arrest is still high. Interestingly, target temperature slightly above the corridor of 32-34°C is associated with increased mortality. Furthermore, in this large cohort NSE has been shown to be a good predictor of long-term mortality with a cut-off markedly higher than previously proposed in the pre-hypothermia era.
- © 2012 by American Heart Association, Inc.