Journal of the Formosan Medical Association (Aug 2020)

Targeted temperature management and emergent coronary angiography are associated with improved outcomes in patients with prehospital return of spontaneous circulation

  • Jr-Jiun Lin,
  • Chien-Hua Huang,
  • Wen-Jone Chen,
  • Po-Ya Chuang,
  • Wei-Tien Chang,
  • Wei-Ting Chen,
  • Min-Shan Tsai

Journal volume & issue
Vol. 119, no. 8
pp. 1259 – 1266

Abstract

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Background/Purpose: Whether targeted temperature management (TTM) and emergent coronary angiography (CAG) remain associated with better outcomes in patients with prehospital return of spontaneous circulation (ROSC) was unknown. Methods: This retrospective cohort study enrolled 81 adult, nontraumatic out-of-hospital cardiac arrest patients who had good pre-arrest neurological function and achieved prehospital ROSC during 2012 to August 2017. The outcomes were survival-to-discharge and neurological recovery at discharge. Results: Fifty-five patients (67.9%) survived to hospital discharge (the survivor group) and twenty-six (32.1%) failed (the non-survivor group). A total of 47 patients (58.0%) presented favorable neurological outcomes [Cerebral Performance Category (CPC) score = 1–2, the favorable group], and 34 patients (42.0%) presented unfavorable neurological outcomes (CPC score = 3–5, the poor group). The survivor group had more patients with TTM (45.5% vs. 19.2%, p = 0.023) and emergent CAG (76.4% vs. 19.2%, p < 0.001) than the non-survivor group, and similar findings were noted in the neurological outcomes (TTM: 44.7% vs. 26.5%, p = 0.094; CAG: 80.9% vs. 26.5%, p < 0.001). TTM remained associated with increased survival-to-discharge [odds ratio (OR) = 14.635, 95% confidence interval (CI) = 1.296–165.305, p = 0.030] and a trend toward good neurological recovery (OR = 4.551, 95%CI = 0.963–21.517, p = 0.056). After excluding patients with rapid neurological recovery after ROSC (n = 70), TTM was associated with good neurological outcomes (OR = 4.534, 95% CI = 1.075–19.127, p = 0.040). Emergent CAG had the trend associated with survival-to-discharge (OR = 9.599, 95%CI = 0.764–120.634, p = 0.080) and was significantly associated with good neurological outcomes (OR = 21.785, 95%CI = 2.004–236.836, p = 0.011). Conclusion: In patients with prehospital ROSC, both TTM and emergent CAG were associated to improved survival and neurological outcomes.

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