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Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in the US, with a survival rate that is less than 10% and with many of them surviving with poor neurologic status. Therapeutic hypothermia (TH) is the only therapy shown to improve neurologically intact survival post cardiac arrest. Post cardiac arrest syndrome is a complex state that includes myocardial dysfunction, neurologic injury and severe systemic inflammation. Previous literature suggests statins may have a beneficial role in other critical illnesses via several mechanisms including an anti-inflammatory pathway and improving endothelial function. Hypothesis: We hypothesized that previous statin use would be associated with improved survival with good neurologic outcome as defined by Cerebral Performance Category score of (1- 2) in OHCA patients with return of spontaneous circulation (ROSC) that undergo TH. Methods: This was a retrospective observational cohort study of 165 patients who presented with OHCA and underwent TH over a 3 year period. We used logistic regression to assess for an association between prior statin use and outcomes and used multivariate logistic-regression to adjust for age, history of coronary artery disease, initial lactate, apache score, down time, and initial cardiac rhythm. Odds ratios and 95% CI are reported. Results: Baseline demographics including age and sex were similar between the two groups. 36 patients had prior statin use, and 129 patients did not. The survival to discharge was 52% in the statin group vs. 38% in the non-statin group (OR 1.825: 95% CI 0.867-3.842) (p=0.11). 50% of patients in the statin group had a good neurologic outcome, as compared to 31% in the non-statin group (OR 2.071: 95% CI 0.979-4.385) (p = 0.057). After adjusting for the above mentioned clinical variables, the positive trend for increased survival was lost, but the trend for survival with good neurologic outcome remained with an OR of 1.147: 95% CI 0.197-6.696 (p=0.88). Conclusions: In this pilot investigation, we observed a trend toward improved survival and neurologic outcomes with previous statin use. After correcting for important clinical variables this positive trend in survival with good neurologic outcome remained, though not statistically significant. Further study is needed to assess the potential contribution of statins on outcomes in patients with OHCA on TH.