Abstract 239: A Characterization of Patients Experiencing Primary and Repeat Cardiac Arrest with and Without Targeted Temperature Management
Background: Incidence of re-arrest following return of spontaneous circulation (ROSC) after an initial cardiac arrest (CA) event is poorly understood. There are few published data describing the frequency of this phenomenon or patient factors associated with re-arrest.
Objective: To measure incidence of re-arrest and to assess patient characteristics associated with re-arrest in a multicenter cohort.
Methods: We performed a retrospective cohort study of CA patients from 5/2005-6/2014 in two urban academic medical centers that employ the same post-arrest care protocol. We collected basic demographic information, initial arrest rhythm, location of initial arrest and survival to discharge.
Results: Of all 3363 patients who experienced in- or out-of-hospital initial CA, 1760 (52%) achieved and maintained ROSC for at least 20 minutes. Subsequent re-arrest occurred in 351/1760 (20%) of patients, with 48/351 (14%) suffering re-arrest within the first hour of ROSC, and 235/351 (67%) suffering re-arrest within the first 24 hours. Median age was indistinguishable between patients who re-arrested and those who did not (63 (IQR 51,73) vs 63 (IQR 51,74), p=ns), nor was gender statistically associated with re-arrest. Shockable initial arrest rhythms were equally represented in both groups as well (90/351 (26%) in re-arrest, 375/1409 (27%) in those who did not re-arrest). Patients who suffered initial in-hospital CA were twice as likely to experience re-arrest as compared to those who had out-of-hospital initial CA (p<0.001). Survival to discharge was 70/348 (20%) among patients who rearrested, and 624/1354 (46%) among patients without re-arrest (p<0.001).
Conclusion: In this cohort of patients, demographics were similar in both re-arrest and no re-arrest populations. About one-fifth of patients who achieved ROSC after initial CA rearrested. Re-arrest was not associated with any specific initial arrest rhythm. In-hospital initial CA was associated with a significantly higher re-arrest incidence. Patients experiencing re-arrest were significantly less likely to survive to discharge than those without re-arrest.
Author Disclosures: K. Sheak: None. G. Delfin: None. A. Grossestreuer: None. M. Cinousis: None. M. Karamooz: None. D. Levine: None. M. Leary: Ownership Interest; Modest; Resuscor LLC. Research Grant; Significant; AHA. B.S. Abella: Research Grant; Significant; NIH, medtronic, stryker. Honoraria; Modest; velomedix, bard, heartsine. Ownership Interest; Modest; resuscor.
- © 2014 by American Heart Association, Inc.