Abstract P159: Causes of Late Death in Patients Discharged Alive after In-hospital Cardiac Arrest: Arrhythmic or Not?

Abstract

Background Survival to discharge after in-hospital cardiopulmonary resuscitation (CPR) is approximately 17%. Data on longer-term survival is scarce and 1-year survival varies between 50 to 80% for patients who survived to discharge. The cause of late death in this patient population is unknown. However, this is of great importance for therapeutic considerations such as prevention of arrhythmic death with an implantable cardiac defibrillator (ICD). Therefore, we obtained long-term survival and the cause of death of patients surviving to discharge after in-hospital cardiac arrest. Methods Single centre study of consecutive in-hospital cardiac arrest patients ≥ 18 years. The cause of late death was based on data obtained from medical records, interviews with general practitioners or if available, autopsy reports. Deaths were classified according to a modified scheme for deaths used in antiarrhythmic trials. Results Between 1997 and 2004 a total of 222 in-hospital cardiac arrest patients underwent CPR and 42 (19%) patients survived to discharge. After a median follow-up of 2.9 years (IQR 1.5–7.2) 18 (43%) patients had died. There were 6 cardiac and 12 non-cardiac causes of death (table ). Of the cardiac causes 2 were arrhythmic and 4 non-arrhythmic. Amongst the 18 deceased patients 7 had ventricular fibrillation at the in-hospital cardiac arrest and thus an indication for an ICD. Of these patients one eventually had an arrhythmic cause of death. Conclusion In this study of patients discharged alive after in-hospital cardiac arrest 3-year survival was 60%. Surprisingly a late cause of death of cardiac origin was found in only a third of the patients and was mostly non-arrhythmic. Of the 7 patients with a current ICD-indication after the index event only one had a potentially preventable arrhythmic cause of late death. Validation of these findings in larger studies seems warranted.