In-hospital mortality after out-of-hospital cardiac arrest
Summary In-hospital management of out-of-hospital cardiac arrest is complicated by uncertainty about prognosis and the need to identify markers of adverse outcome in individuals surviving initial resuscitation. We sought to identify factors that predict in-hospital death among patients who initially...
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| Veröffentlicht in: | The Lancet (British edition) 1995-08, Vol.346 (8972), p.417-421 |
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| creator | Grubb, N.R Fox, K.A.A Elton, R.A |
| description | Summary
In-hospital management of out-of-hospital cardiac arrest is complicated by uncertainty about prognosis and the need to identify markers of adverse outcome in individuals surviving initial resuscitation. We sought to identify factors that predict in-hospital death among patients who initially survive out-of-hospital cardiac arrest.
We investigated 346 consecutive cases of out-of-hospital cardiac arrest received by a single centre in Edinburgh, UK (270 cases examined retrospectively, 76 prospectively). Of the retrospective cohort, 246 cases were thought to be of cardiac origin. There were associations between in-hospital mortality and pre-arrest variables, resuscitation variables, and factors measured during admission. Crew-witnessed arrests were associated with low mortality; arrest rhythm (p |
| doi_str_mv | 10.1016/S0140-6736(95)92784-0 |
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In-hospital management of out-of-hospital cardiac arrest is complicated by uncertainty about prognosis and the need to identify markers of adverse outcome in individuals surviving initial resuscitation. We sought to identify factors that predict in-hospital death among patients who initially survive out-of-hospital cardiac arrest.
We investigated 346 consecutive cases of out-of-hospital cardiac arrest received by a single centre in Edinburgh, UK (270 cases examined retrospectively, 76 prospectively). Of the retrospective cohort, 246 cases were thought to be of cardiac origin. There were associations between in-hospital mortality and pre-arrest variables, resuscitation variables, and factors measured during admission. Crew-witnessed arrests were associated with low mortality; arrest rhythm (p<0·001), resuscitation by a health professional (p<0·05), conscious level on admission (p<0·001), and requirement for ventilaton (p<0·05) independently predicted in-hospital mortality. A weighted prognostic scoring system based on three of these variables accurately predicted the likelihood of in-hospital death in the prospective test group. Further assessment of conscious level during admission with the Glasgow coma score predicted mortality rates in the study population, but coma did not predict a hopeless prognosis in individual cases unless it persisted for 72 h or more.
Accurate prognostic assessment of out-of-hospital cardiac arrest survivors can be made from information available on admission. Of factors that independently predicted outcome, the skill of the resuscitator is most readily modified. This suggests that public training in resuscitation may reduce mortality rates.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(95)92784-0</identifier><identifier>PMID: 7623574</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiac arrest ; Cardiopulmonary Resuscitation ; Cohort Studies ; Coma ; Consciousness ; CPR ; Edinburgh ; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care ; Emergency Medical Services ; Female ; Glasgow Coma Scale ; Heart ; Heart Arrest - etiology ; Heart Arrest - mortality ; Heart Arrest - therapy ; Heart attacks ; Hospital Mortality ; Hospitals ; Humans ; Intensive care medicine ; Male ; Medical personnel ; Medical research ; Medical sciences ; Middle Aged ; Mortality ; Myocardial infarction ; Patient Admission ; Patients ; Population studies ; Prognosis ; Prospective Studies ; Resuscitation ; Retrospective Studies ; Scotland - epidemiology ; Survival ; Training ; Treatment ; Treatment Outcome</subject><ispartof>The Lancet (British edition), 1995-08, Vol.346 (8972), p.417-421</ispartof><rights>1995</rights><rights>1995 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Aug 12, 1995</rights><rights>Copyright Elsevier Limited Aug 12, 1995</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-deb90ebefc2a1b0f7bd76dc413cd8a50a574dc63fcd657ceda2003c122bfc4b83</citedby><cites>FETCH-LOGICAL-c475t-deb90ebefc2a1b0f7bd76dc413cd8a50a574dc63fcd657ceda2003c122bfc4b83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673695927840$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,30977,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3631577$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7623574$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grubb, N.R</creatorcontrib><creatorcontrib>Fox, K.A.A</creatorcontrib><creatorcontrib>Elton, R.A</creatorcontrib><title>In-hospital mortality after out-of-hospital cardiac arrest</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary
In-hospital management of out-of-hospital cardiac arrest is complicated by uncertainty about prognosis and the need to identify markers of adverse outcome in individuals surviving initial resuscitation. We sought to identify factors that predict in-hospital death among patients who initially survive out-of-hospital cardiac arrest.
We investigated 346 consecutive cases of out-of-hospital cardiac arrest received by a single centre in Edinburgh, UK (270 cases examined retrospectively, 76 prospectively). Of the retrospective cohort, 246 cases were thought to be of cardiac origin. There were associations between in-hospital mortality and pre-arrest variables, resuscitation variables, and factors measured during admission. Crew-witnessed arrests were associated with low mortality; arrest rhythm (p<0·001), resuscitation by a health professional (p<0·05), conscious level on admission (p<0·001), and requirement for ventilaton (p<0·05) independently predicted in-hospital mortality. A weighted prognostic scoring system based on three of these variables accurately predicted the likelihood of in-hospital death in the prospective test group. Further assessment of conscious level during admission with the Glasgow coma score predicted mortality rates in the study population, but coma did not predict a hopeless prognosis in individual cases unless it persisted for 72 h or more.
Accurate prognostic assessment of out-of-hospital cardiac arrest survivors can be made from information available on admission. Of factors that independently predicted outcome, the skill of the resuscitator is most readily modified. This suggests that public training in resuscitation may reduce mortality rates.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrest</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Cohort Studies</subject><subject>Coma</subject><subject>Consciousness</subject><subject>CPR</subject><subject>Edinburgh</subject><subject>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Heart</subject><subject>Heart Arrest - etiology</subject><subject>Heart Arrest - mortality</subject><subject>Heart Arrest - therapy</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Patient Admission</subject><subject>Patients</subject><subject>Population studies</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Resuscitation</subject><subject>Retrospective Studies</subject><subject>Scotland - epidemiology</subject><subject>Survival</subject><subject>Training</subject><subject>Treatment</subject><subject>Treatment Outcome</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkV1rFDEUhkOx1O3HTygsKkUvxp5k8jHxRqSoLRS8aAXvQuYkwZTZyZrMCP33prvLCoL06ly8z_lIHkLOKbynQOXlHVAOjVStfKvFO81Uxxs4IAvKFW8EVz9ekMUeeUmOS3kAAC5BHJEjJVkrFF-QDzdj8zOVdZzssFylXEucHpc2TD4v0zw1KfzN0WYXLS5tzr5Mp-Qw2KH4s109Id-_fL6_um5uv329ufp02yBXYmqc7zX43gdklvYQVO-UdMhpi66zAmy9w6FsAzopFHpnGUCLlLE-IO-79oRcbOeuc_o118VmFQv6YbCjT3MxSnFKmRLPgnVRxyjXFXz9D_iQ5jzWRxjGQGsFcjPu1f8oqjsthJa8QmILYU6lZB_MOseVzY-GgnnyZDaezJMEo4XZeDJQ-853w-d-5d2-ayem5m92uS1oh5DtiLHssVa2VChVsY9bzFcBv6PPpmD0Y_3FmD1OxqX4zCF_ANZkrg0</recordid><startdate>19950812</startdate><enddate>19950812</enddate><creator>Grubb, N.R</creator><creator>Fox, K.A.A</creator><creator>Elton, R.A</creator><general>Elsevier Ltd</general><general>Lancet</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>19950812</creationdate><title>In-hospital mortality after out-of-hospital cardiac arrest</title><author>Grubb, N.R ; Fox, K.A.A ; Elton, R.A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-deb90ebefc2a1b0f7bd76dc413cd8a50a574dc63fcd657ceda2003c122bfc4b83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac arrest</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Cohort Studies</topic><topic>Coma</topic><topic>Consciousness</topic><topic>CPR</topic><topic>Edinburgh</topic><topic>Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Heart</topic><topic>Heart Arrest - etiology</topic><topic>Heart Arrest - mortality</topic><topic>Heart Arrest - therapy</topic><topic>Heart attacks</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Patient Admission</topic><topic>Patients</topic><topic>Population studies</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Resuscitation</topic><topic>Retrospective Studies</topic><topic>Scotland - epidemiology</topic><topic>Survival</topic><topic>Training</topic><topic>Treatment</topic><topic>Treatment 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edition)</jtitle><addtitle>Lancet</addtitle><date>1995-08-12</date><risdate>1995</risdate><volume>346</volume><issue>8972</issue><spage>417</spage><epage>421</epage><pages>417-421</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary
In-hospital management of out-of-hospital cardiac arrest is complicated by uncertainty about prognosis and the need to identify markers of adverse outcome in individuals surviving initial resuscitation. We sought to identify factors that predict in-hospital death among patients who initially survive out-of-hospital cardiac arrest.
We investigated 346 consecutive cases of out-of-hospital cardiac arrest received by a single centre in Edinburgh, UK (270 cases examined retrospectively, 76 prospectively). Of the retrospective cohort, 246 cases were thought to be of cardiac origin. There were associations between in-hospital mortality and pre-arrest variables, resuscitation variables, and factors measured during admission. Crew-witnessed arrests were associated with low mortality; arrest rhythm (p<0·001), resuscitation by a health professional (p<0·05), conscious level on admission (p<0·001), and requirement for ventilaton (p<0·05) independently predicted in-hospital mortality. A weighted prognostic scoring system based on three of these variables accurately predicted the likelihood of in-hospital death in the prospective test group. Further assessment of conscious level during admission with the Glasgow coma score predicted mortality rates in the study population, but coma did not predict a hopeless prognosis in individual cases unless it persisted for 72 h or more.
Accurate prognostic assessment of out-of-hospital cardiac arrest survivors can be made from information available on admission. Of factors that independently predicted outcome, the skill of the resuscitator is most readily modified. This suggests that public training in resuscitation may reduce mortality rates.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>7623574</pmid><doi>10.1016/S0140-6736(95)92784-0</doi><tpages>5</tpages></addata></record> |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Elsevier ScienceDirect Journals; EBSCOhost Business Source Complete |
| subjects | Adult Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiac arrest Cardiopulmonary Resuscitation Cohort Studies Coma Consciousness CPR Edinburgh Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Emergency Medical Services Female Glasgow Coma Scale Heart Heart Arrest - etiology Heart Arrest - mortality Heart Arrest - therapy Heart attacks Hospital Mortality Hospitals Humans Intensive care medicine Male Medical personnel Medical research Medical sciences Middle Aged Mortality Myocardial infarction Patient Admission Patients Population studies Prognosis Prospective Studies Resuscitation Retrospective Studies Scotland - epidemiology Survival Training Treatment Treatment Outcome |
| title | In-hospital mortality after out-of-hospital cardiac arrest |
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