Factors Influencing Survival and Neurological Outcomes Following Cardiac Arrest Open Access

Trammell, Antoine Raynard (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/jm214p70n?locale=en
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Abstract

Survival to discharge rates following cardiac arrest have not improved over 60 years despite research. The post-cardiac arrest period has been considered treatable since 1966, however, the primary focus of cardiac arrest research has been the return of spontaneous circulation. The greatest reduction in survivorship following cardiac arrest occurs in the period following return of spontaneous circulation during the post-cardiac arrest syndrome, characterized by neurological and cardiac dysfunction. Cardiac arrest outcomes also present public health challenges as neurological deterioration increases long-term care costs and decreases quality of life. Survival disparities per ethnic background have also been reported. As the efficacy of interventions after cardiac arrest period to improve outcomes have been shown, the purpose of this investigation is to identify factors during post-cardiac arrest care that impacts outcomes.

Methods: An investigation of 271 cardiopulmonary arrest events over a two-year period at a single center. Code documentation and post-arrest course at 6, 12, 24, and 48 hours was reviewed.

Results: Baseline characteristics among patients are similar. Among the patients 172 (66.7%) survived the event of which 52 (19.2%) survived to discharge. The Cerebral Performance Category score of patients surviving to discharge differs from patients not surviving to discharge (2 vs 5, p < 0.0001). In multivariate analyses, neurological status (9.30, 3.51-24.65, p < 0.0002) and mean arterial pressure at 24-hours (OR 1.03, 1.02-1.04, p < 0.0001) are associated with survival to discharge. Mean arterial pressure at 6-hours (OR 1.27, 1.01-1.03, p = 0.004) and 24-hours (OR 1.02, 1.01-1.02, p < 0.0001) are associated with neurological preservation. Survival analyses demonstrate increased survival to 48-hours with neurological preservation (p < 0.0001), higher pH (p < 0.001), and higher mean arterial pressure (p = 0.002). Survivors with neurological deterioration have a greater risk of not surviving to discharge (HR 2.73, 1.83-4.08, p < 0.001).

Summary: Patients with neurological preservation following cardiac arrest have better survival outcomes. Factors favoring neurological preservation include systemic perfusion and systemic ischemia. Further investigation and development of post-cardiac care strategies have the potential to address disparate outcomes and healthcare costs.

Table of Contents

Page 1: Introduction and Literature Review

Page 11: Design and Methodology

Page 18: Data, Analysis, and Results

Page 21: Discussion

Page 24: References

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