Abstract 18150: Ventricular Arrhythmia During Post Cardiac Arrest Care: Prognostic Importance and Influence of Pre-hospital Defibrillation - A TTM Substudy
Background: Ventricular arrhythmias (VA) are life threatening, even in patients admitted to an intensive care unit following out-of-hospital cardiac arrest (OHCA). Post cardiac arrest care includes hemodynamic stabilization and targeted temperature management (TTM) and while most patients are stabilized, VA may occur. We assessed the prognosis of OHCA patients with in-hospital VA and whether the number of pre-hospital defibrillations was predictive of in-hospital arrhythmic events.
Method: We studied 934 (99%) comatose OHCA survivors from the TTM-trial (year: 2010-13) with available data on VA during the first 2 days of post cardiac arrest care and the number of pre-hospital defibrillation used to achieve return of spontaneous circulation (ROSC). The TTM trial showed no benefit of TTM at 33°C over 36°C in terms of mortality and neurological outcome.
Results: The prevalence of VA was 16% and did not differ between the TTM groups (33°C= 82 (17%) vs. 36°C= 67 (15%), p=0.23). Patients with VA had similar 180-day survival rates (VA= 52% vs. no-VA= 53%, plog-rank= 0.63, Figure) and odds of unfavorable neurological outcome (OR=1.04 (0.73-1.48, p=0.83), compared to patients without VA. The number of pre-hospital defibrillations ranged from 0 to >20 and a twofold increase was associated with significantly higher odds of in-hospital VA, both combined (OR= 1.39 (1.22-1.59, p<0.0001), and separately as risk of ventricular tachycardia (OR= 1.39 (1.20-1.60, p<0.0001) and fibrillation (OR= 1.54 (1.23-1.93 p<0.001). This remained significant when adjusting for STEMI, initial rhythm, age, sex, bystander CPR, time to ROSC and admission lactate.
Conclusion: Risk of VA is directly related to the number of pre-hospital defibrillations, which may be of value in predicting patients at risk of arrhythmia. VA occurring during post cardiac arrest care has no significant impact on prognosis, which supports continued active treatment in patients with recurrent VA after OHCA.
- out-of-hospital cardiac arrest
- ventricular arrhythmia
- pre-hospital defibrillation
- Targeted temperature management
Author Disclosures: J.H. Thomsen: Research Grant; Significant; The Danish Heart Foundation [Grant no: 13-04-R94-A4460-22756] has supported this study with 12 month of salary in JHT’s PhD project.. J. Kjærgaard: None. N. Nielsen: None. D. Erlinge: None. M. Wanscher: None. Y. Gashe: None. H. Friberg: None. S. Pehrson: None. L. Køber: None. C. Hassager: None.
- © 2015 by American Heart Association, Inc.