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Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry)


Affiliations
1 Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
2 Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
3 Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Cambodia
 

Objective: Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with highmortality. Combiningmild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design: A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results: The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In theMTH + C andMTH + NC groups, the inhospital mortality was 48%and 78%, respectively.The only independent predictor of in-hospital mortality for patients withMTH+ C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8-47.1, and p = 0.009). Conclusion: Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.
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  • Renal Insufficiency and Early Bystander CPR Predict In-Hospital Outcomes in Cardiac Arrest Patients undergoing Mild Therapeutic Hypothermia and Cardiac Catheterization: Return of Spontaneous Circulation, Cooling, and Catheterization Registry (ROSCCC Registry)

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Authors

Anjala Chelvanathan
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
David Allen
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
Hilary Bews
Institute of Cardiovascular Sciences, St. Boniface Research Centre, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
John Ducas
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
Kunal Minhas
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
Minh Vo
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
Malek Kass
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
Amir Ravandi
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
James W. Tam
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
Davinder S. Jassal
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Canada
Farrukh Hussain
Section of Cardiology, Department of Internal Medicine, University of Manitoba,Winnipeg, MB, R2H 2A6, Cambodia

Abstract


Objective: Out of hospital cardiac arrest (OHCA) patients are a critically ill patient population with highmortality. Combiningmild therapeutic hypothermia (MTH) with early coronary intervention may improve outcomes in this population. The aim of this study was to evaluate predictors of mortality in OHCA patients undergoing MTH with and without cardiac catheterization. Design: A retrospective cohort of OHCA patients who underwent MTH with catheterization (MTH + C) and without catheterization (MTH + NC) between 2006 and 2011 was analyzed at a single tertiary care centre. Predictors of in-hospital mortality and neurologic outcome were determined. Results: The study population included 176 patients who underwent MTH for OHCA. A total of 66 patients underwent cardiac catheterization (MTH + C) and 110 patients did not undergo cardiac catheterization (MTH + NC). Immediate bystander CPR occurred in approximately half of the total population. In theMTH + C andMTH + NC groups, the inhospital mortality was 48%and 78%, respectively.The only independent predictor of in-hospital mortality for patients withMTH+ C, after multivariate analysis, was baseline renal insufficiency (OR = 8.2, 95% CI 1.8-47.1, and p = 0.009). Conclusion: Despite early cardiac catheterization, renal insufficiency and the absence of immediate CPR are potent predictors of death and poor neurologic outcome in patients with OHCA.