Incidence, outcomes and characteristics of rearrest after out-of-hospital cardiac arrest

[摘要] Out-of-hospital cardiac arrest (OHCA) results in nearly 350,000 deaths in the United States annually. Survival after OHCA is dismal, with regional estimates suggesting an overall case fatality rate of between 92% and 96%. High mortality following OHCA persists despite advances in resuscitation methodology that result in the successful resuscitation of a substantial fraction of patients (~40%). It is known that some patients experience another OHCA after resuscitation. This secondary OHCA, called rearrest, has not been extensively characterized, but it is known that rearrest correlates with poor OHCA survival prognosis after OHCA. Further understanding of rearrest may enable its prevention and development of optimal treatment strategies, potentially increasing survival after OHCA.Utilizing data from the OHCA surveillance program of the Resuscitation Outcomes Consortium, this dissertation addresses the need for further characterization of rearrest, focusing on patient, treatment, and electrocardiographic characteristics.The results of this study indicate several characteristics that distinguish cases with and without rearrest. Of these, median income and electrocardiographic characteristics derived from the QT-interval were the most robustly associated with rearrest case status. Time-to-rearrest was correlated with rearrest event number, presenting OHCA electrocardiogram rhythm, and whenmeasured over the first 5-minutes following resuscitation in patients with rearrest, standard deviation of heart rate.While the characterization of rearrest cases was comprehensively reported with the available data in this study, limited inference could be drawn regarding the prediction and prevention of rearrest due to a lack of patient history data and a large amount of missing electrocardiographic data. Still, this study lays down a clear path to future research, indicating promising directions for further filling in the knowledge gaps necessary to increase survival after OHCA.The public health significance of this work is rooted in the identification and characterization of an important determinant of a major source of mortality in the developed world, OHCA. The findings of this study provide a novel basis for further investigations aiming to save some of the hundreds of thousands of lives that are claimed by OHCA each year, potentially through public health interventions executed through emergency medical services.

[发布机构] the University of Pittsburgh