PURPOSE: Many studies have investigated the factors associated with neurological outcomes after cardiac arrest using national registry databases. We analyzed a database of all IHCA patients admitted to the MICU of an urban, community teaching hospital over a six year period to identify the factors associated with good neurological outcome.
METHODS: A retrospective chart review of 7494 patients identified from a MICU admission log from 2003-2009 was performed. 118 IHCA patients were identified and entered into a database. A more extensive chart review was then performed, collecting demographic, clinical, arrest, and outcome data. “Good” neurological outcome was defined as discharge to home or acute rehabilitation facility. Univariate factors associated with the primary outcome were analyzed using chi-square test for categorical variables. Non-parametric Wilcoxon tests were used for continuous variables whose distribution did not meet normality assumptions.
RESULTS: A total of 118 patients admitted to MICU after IHCA from 2003-2009 were identified. Mean age was 68. Females made up 54%. Presenting rhythms were ventricular fibrillation/ ventricular tachycardia in 10%, pulseless electrical activity in 56%, and asystole in 33%. 13% of patients had good neurological outcome. Patients with good outcomes were younger than those with poor outcomes (58.1 vs. 69.8 years, p<0.05) and had shorter duration of arrest (5 vs. 10 min: p<0.05). Other statistically significant factors associated with outcome were limited to the presence of terminal illness and pre-morbid functional status (6% vs. 20%: p<0.05 and 8% vs. 23%, p<0.05). Gender, arrest rhythm, and location of cardiac arrest were not correlated with outcome. Co-morbidities such as heart disease, stroke, dialysis dependence, and malignancy did not have correlation with outcomes.
CONCLUSION: Age, arrest duration, presence of terminal illness and functional status were the only statistically significant predictors of outcome in a population of IHCA patients admitted to an MICU.
CLINICAL IMPLICATIONS: Knowledge of predictors of poor outcome after IHCA may help inform end-of life care discussions and treatment decisions.
DISCLOSURE: Mayuko Fukunaga, No Financial Disclosure Information; No Product/Research Disclosure Information