Abstract 10964: Hyperfibrinolysis in Patients With out of Hospital Cardiac Arrest May Contribute to Poor Outcome

Abstract

Introduction: Hyperfibrinolysis (HF) in out-of-hospital cardiac arrest (OHCA) is often encountered in the emergency department (ED). However, only a few studies on the coagulopathy in post cardiac arrest syndrome (PCAS) were reported and it still remains a matter of debate. In recent years, thromboelastometry (ROTEM ® ), known as point-of-care testing, quickly provides a more complete picture of coagulation and fibrinolytic status. Hypothesis: We hypothesized that HF diagnosed by ROTEM in OHCA might be associated with poor outcome. Methods: 48 OHCA patients transported to the Saga University Hospital with ROTEM performed in the ED from January 2013 to December 2014 were enrolled in this study. A 15% or more of maximum lysis (ML) in EXTEM test and a 20 % or more improvement of ML in APTEM test compared with that in EXTEM were defined as HF. All patients were divided into two groups based on the presence of HF. Clinical characteristics, initial cardiac rhythms at the scene and ED, time from onset to blood sampling, complete blood test, standard coagulation test, blood gas analysis, ROTEM findings (EXTEM/ INTEM/ FIBTEM/ APTEM) and clinical outcome were evaluated. Results: HF was observed 72% of all OHCA patients, which wasn’t significantly related to epinephrine injection before blood sampling (p=0.510). Univariate analysis revealed that HF contributed to lower CRP values (p=0.050) and accelerated fibrinolytic parameters of ROTEM (EXTEM/INTEM/FIBTEM; p<0.01). Any other parameters including initial cardiac rhythms and time from onset to blood sampling were not significantly different in the two groups. As for clinical outcome, the ratio of return of spontaneous circulation (ROSC) reached 10% (before the ED), 40% (after the ED), 18.8% (6hours after admission), 12.5% (24hours after admission), respectively. There was no statistical difference between HF and clinical outcome in this period. However, it should be noted that only 2 patients (4.2%) without HF survived for more than 28 days. HF had a tendency to poor 28-day mortality (p=0.069). In addition, Kaplan-Meier and log-rank analysis showed HF was a predictive factor for poor outcome of PCAS (p=0.099). Conclusions: HF in OHCA is associated with poor clinical outcome.