282 Prognostic Factors for Good Neurologic Outcome in Patients With Prolonged Resuscitation Efforts

Abstract

Neurologically intact survival after cardiac arrest can still occur in patients with prolonged downtime. It is unknown which factors associated with outcome in prolonged downtime patients treated with targeted temperature management (TTM). The present study aimed to determine the factors associated with neurologic intact survival in prolonged downtime, defined as >20 minutes, out-of-hospital cardiac arrest (OHCA) patients. Multicenter, registry-based, retrospective cohort study conducted in 24 hospitals across South Korea between January 2007 and December 2012. We included adult (≥18 years) non-traumatic OHCA patients who had prolonged downtime and treated with TTM. We defined downtime as the length of time between the patient being recognized as pulseless and return of spontaneous circulation. Good neurologic outcome defined as a cerebral performance category score of 1 or 2. Of the 930 OHCA patients treated with TTM, 254 were excluded, leaving 676 patients with prolonged downtime entering analysis. Mean age was 56.9 years and 150 patients (22.2%) had good neurologic outcome. After multivariable logistic regression analysis, age <60 years (OR 2.92, 95% CI 1.64 – 5.19), initial shockable rhythm (OR 6.75, 95% CI 4.02 – 11.33), no comorbidity (OR 2.12, 95% CI 1.26 – 3.58), downtime intervals [ORs and 95% CIs 0.59 (0.33 – 1.04), 0.43 (0.21 – 0.87), 0.17 (0.06 – 0.47), and 0.14 (0.03 – 0.52) for 30-39 min, 40-49 min, 50-59 min, and ≥ 60 min, respectively], and witnessed arrest (OR 1.88, 95% CI 1.05 – 3.35) were associated with good neurologic outcome. Chance of good neurologic outcome in OHCA patients with prolonged downtime decreased as downtime increases. However young age, shockable rhythm, no previous comorbidity, and witnessed arrest were prognostic factors for good neurologic outcome in patients with prolonged resuscitation efforts.