Abstract
Objective Heart rate (HR), an essential vital sign that reflects hemodynamic stability, is influenced by myocardial oxygen demand, coronary blood flow, and myocardial performance. HR at the time of the return of spontaneous circulation (ROSC) could be influenced by the β1-adrenergic effect of the epinephrine administered during cardiopulmonary resuscitation (CPR), and its effect could be decreased in patients who have the failing heart. We aimed to investigate the association between HR at the time of ROSC and the outcomes of adult out-of-hospital cardiac arrest (OHCA) patients. Methods This study was a secondary analysis of a cardiac arrest registry from a single institution from January 2008 to July 2014. The OHCA patients who achieved ROSC at the emergency department (ED) were included, and HR was retrieved from an electrocardiogram or vital sign at the time of ROSC. The patients were categorized into four groups according to the HR (bradycardia (HR < 60), normal HR (60 ≤ HR ≤ 100), tachycardia (100 < HR < 150), and extreme tachycardia (HR ≥ 150)). The primary outcome was the rate of sustained ROSC and the secondary outcomes were the rate of one-month survival and six-month good neurologic outcome. Results A total of 330 patients were included. In the univariate logistic regression model, the rate of sustained ROSC increased by 17% as HR increased by every 10 beats per minute (bpm) (odds ratio (OR), 1.171; 95% confidence interval (CI), 1.077–1.274, p < 0.001). In the multivariate logistic regression model, extreme tachycardia was independently associated with a high probability of sustained ROSC compared to normal heart rate (OR, 15.96; 95% CI, 2.04–124.93, p=0.008). Conclusion Extreme tachycardia (HR ≥ 150) at the time of ROSC is independently associated with a high probability of sustained ROSC in nontraumatic adult OHCA patients.
Highlights
Out-of-hospital cardiac arrest (OHCA) is still a major challenge in medicine despite many efforts to improve outcomes
Given that the cardiac dysfunction after return of spontaneous circulation (ROSC) showed significant morbidity and mortality [14], we hypothesized that the heart rate (HR) at the time of ROSC, which might reflect the cardiac function, could be associated with the outcome of OHCA. erefore, we investigated the association between HR at the time of ROSC and the probability of sustained ROSC
We performed a secondary analysis of consecutive OHCA databases in a single ED from January 2008 to July 2014. e study facility was a 1250-bed urban tertiary academic hospital with an annual ED census of approximately 85,000. is study was approved by the Institutional Review Board (IRB) of Seoul National University Bundang Hospital and reported according to the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for reporting observational trials [15]
Summary
Out-of-hospital cardiac arrest (OHCA) is still a major challenge in medicine despite many efforts to improve outcomes. In patients with OHCA, the rate of the return of spontaneous circulation (ROSC) has been reported to be from 24 to 44% [1,2,3]. Among patients who experience ROSC after OHCA, rearrest often develops within a short time and results in death. Most in-hospital deaths after ROSC are due to cardiac dysfunction and neurologic failure in postcardiac arrest syndrome, and early death is mainly due to cardiac dysfunction [4,5,6]. Cardiac dysfunction after ROSC is known to be reversible and cardiac function resumes after 48 to 72 hours, severe cardiac dysfunction prevents the maintenance of ROSC and may result in rearrest [7]. When ROSC is achieved, blood pressure and heart rate (HR) are usually measured immediately. HR, an essential vital sign that reflects hemodynamic stability, influences myocardial oxygen demand, coronary blood flow, and myocardial performance [8,9,10]
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