Abstract 291: Interaction Between Diabetes and Hypothermia on Outcomes After Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study
Objective: To determine whether diabetes mellitus (DM) has an interaction effect with the mild therapeutic hypothermia (MTH) on brain recovery after emergency medical services (EMS) assessed out-of-hospital cardiac arrest (OHCA) survivors.
Methods: We included all OHCA patients survived to admission with presumed cardiac etiology (Jan. 2009 to Dec. 2012) from Korean national OHCA registry, excluding cases without available outcome data. The primary exposure was MTH which included all kinds of cooling methods. The endpoints were hospital discharge and discharge with brain recovery (cerebral performance category 1 or 2). DM was defined as PDM-positive when the patient has clinical treatment history or positive at blood laboratory test, NDM- negative in history and test, and UDM- if there is no available laboratory test and history. We compared outcomes between MTH versus non-MTH group using multivariable logistic regression with interaction term between MTH and DM for calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for individual, Utstein, post-resuscitation factors, and comorbidities.
Results: We included 7,516 OHCAs survived to admission. MTH was performed in 14.6% and showed better outcomes than non-MTH group; 54.1% vs. 36.4% in survival discharge and 22.6% vs. 14.1% in good brain recovery (Ps<0.001). Survival to discharge with good brain recovery of all and DM group was 15.3% of all (n=7,516), 17.7% of NDM (n=4,129), 9.7% of PDM (n=1,952), and 16.1% of UDM (n=2,382), respectively. MTH performed has increased by year; 8.6% (2009), 9.9% (2010), 16.1% (2011), and 21.1% (2012). Adjusted OR (95% CI) by MTH for survival to discharge was 1.66 (1.42-1.95) in non-interaction model and 2.08 (1.55-2.81) in NDM, 1.24 (0.88-1.75) in PDM, 1.84 (1.23-2.61) in UDM in interaction model, respectively. Adjusted OR (95% CI) by MTH for discharge with brain recovery was 1.29 (1.04-1.56) in non-interaction model and 1.33 (0.87-2.02) in NDM, 0.59 (0.34-1.04) in PDM, and 0.62 (0.36-1.03) in UDM in interaction model, respectively.
Conclusions: The MTH was associated with better outcomes and is significantly associated with survival to discharge in non-diabetes group, not in diabetes group.
Author Disclosures: Y. Ro: None. S. Shin: None. K. Song: None. E. Lee: None.
- © 2014 by American Heart Association, Inc.