The status of implementation of chain of survival and factors impacting on the outcome of cardiac arrest patients

Abstract

Objective To evaluate the status of implementation of the chain of survival and the gap between the guideline’s recommendations and clinical practice as well as to analyze the factors influencing the prognosis of cardiac arrest (CA) patients. Methods A retrospective analysis of CA in adult patients admitted to Emergency Department of Peking University Third Hospital from January 2012 to December 2013 was carried out. The epidemiology, clinical features, implementations of the chain of survival and outcome were compared between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients, with regard to the analysis of the predictors for survival and neurological outcome. Results A total of 414 patients with 69.8% male and average age of(61.7±18.0)years were divided into two groups, OHCA group(n=190) and IHCA group(n=224). Cardiogenic cause was found in 30% of CA patients. There were 27.5% patients with restoration of spontaneous circulation(ROSC), 8.2% patients discharged in survival and 3.1% patients with good neurologic outcome (CPC=1 and 2). There were higher proportion of medical responders arriving to CA patients within 5 minutes after onset(99.1% vs. 10.5%, P<0.01), bystander carrying out cardiopulmonary resuscitation(100% vs. 15.3%, P<0.01), CPR initiated in 5 minutes(98.7% vs. 11.1%, P<0.01), defibrillation performed in 5 minutes(87.5% vs. 12.5%, P<0.01)in IHCA group compared with OHCA. There were no statistical differences in epinephrine administration and epinephrine dose, and targeted temperature management between two groups. There were higher proportion of ROSC(37.1% vs. 16.3%, P<0.05), higher percentage of survivals discharged (31.0% vs.22.6%, P=0.002)and good neurologic outcome with CPC=1 or 2(48.1% vs.0.0%, P=0.029)in IHCA group compared with OHCA. Location of CA occurred and initial arrhythmia rectifiable with defibrillation treatment after ROSC were the favorable predictors for assessing the percentages of ROSC and survivals discharged. In contrast, male and age over 65 years were the unfavorable predictors of ROSC. Conclusions Improvement in outcome of victims with CA is required in every link of the chain of survival, especially in prehospital rescue act, bystander carrying out CPR, defibrillation, and therapeutic hypothermia in unconscious patients after resuscitation. The effective implementation of chain of survival concept can improve the prognosis of CA patients. Key words: Cardiac arrest; Cardiopulmonary resuscitation; Chain of survival; Prevalence study; Return of spontaneous circulation; Survival rate; Logistic regression; Prognostic factors