The effect of resuscitation characteristics and various demographic factors on outcome after out-of-Hospital cardiac arrest, in the region of Groningen

Kersten, J.H.W. (2016) The effect of resuscitation characteristics and various demographic factors on outcome after out-of-Hospital cardiac arrest, in the region of Groningen. thesis, Medicine.

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Abstract

Abstract Background: An out-of-hospital cardiac arrest (OHCA) is generally associated with poor outcome. Survival rates are higher when cardiopulmonary resuscitation (CPR) is initiated early. Neurological outcome also seems to depend on early CPR, although recent literature about this subject is scarce. Understanding of determinants for survival and neurological outcome is important for creating strategies to improve outcome after OHCA. Objectives: To identify resuscitation characteristics and demographic factors which are associated with survival and neurological outcome after OHCA, in the region of Groningen. Methods: We retrospectively collected data of 400 OHCA-patients that were admitted to the emergency room of the University Medical Center of Groningen between 2010 and 2014. Patients were followed up until either death or 6 months after discharge. Patient conditions, resuscitation characteristics and demographic factors, treatment and outcome were analyzed. Primary outcome was clinical course of neurological outcome, for which we compared the cerebral performance category (CPC) before OHCA with the CPC at discharge. To enable comparing OHCAs in urban areas with OHCAs in rural areas, we used the postal code of the location of the cardiac arrest to determine the urbanization degree. Results: In total 168 out of 400 patients survived until discharge. Early CPR was performed in 269 cases (67.3%). Hospital survival is significantly higher when the patient received early CPR (P-value 0.001). Among the 168 survivors, 110 patients (65.5%) have equal neurological outcome after OHCA compared to before the cardiac arrest. Patients who received early CPR had equal neurological outcome in 68.2% of the cases, compared to 56.4% in patients who did not receive early CPR. Although early CPR does not significantly influence neurological outcome (P-value 0.175), it is strongly associated to a higher score on the Glasgow coma scale (GCS) at admission (P-value 0.010). A higher GCS at admission is a great predictor of equal neurological outcome after OHCA (OR 0.854, P-value 0.012). Demographic factors did influence resuscitation characteristics: CPR rates were higher in rural areas (74.1% versus 55.1%, P-value 0.001) and travel time of emergency medical services is longer in rural areas compared to urban areas (mean travel time 8.2 versus 6.2 minutes, P-value 0.000). Hospital mortality is similar between urban and rural areas (60.2% versus 56.7%, P-value 0.559). Conclusion: This study confirms the association between early CPR and survival. Although early CPR was performed more often in rural areas, survival rates are similar between urban and rural areas. No one-to-one effect has been demonstrated between early CPR and neurological outcome. A prospective study is needed to outline a more clear profile of the predictors for neurological outcome after OHCA, with a more detailed measurement representing the clinical course of neurological outcome.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisors: and Nieuwland, Dr. W. cardiologist and Horst, Dr. J.C.C. van der intensivist and University Medical Center and Groningen and Department of cardiology and and intensive care medicine
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:47
Last Modified:	25 Jun 2020 10:47
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/801

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