Cardiac Arrest in a Community: Epidemiology, Treatment, and Outcome
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Background: Incidence and mortality from sudden cardiac arrest is high, making it a prevalent cause of death. Both incidence and survival rates show great variability between populations. In order to improve survival from sudden cardiac arrest, it is necessary to view aetiology, treatment effects, and outcome as a whole.
Aim: To investigate cardiac arrest incidence, treatment, and outcome in one geographic area during a limited period of time.
Method: Paper I and Paper II prospectively included consecutive patients suffering cardiac arrest in one of our local hospitals, or in the geographical area delivering patients to these hospitals, between 1 December 2008 and 30 November 2009. Paper I compared out-of-hospital cardiac arrest with in-hospital cardiac arrest in terms of Utstein characteristics and survival. Paper II compared cognitive function in cardiac arrest survivors with good neurologic outcome at hospital discharge with an age- and gender-matched reference population. Paper III retrospectively examined consecutive out-of-hospital cardiac arrest survivors from December 2003 to December 2008 admitted to the emergency department in a comatose state. Propensity score matching was used to compare intensive care treatment including targeted temperature management with intensive care treatment not including targeted temperature management in regard to survival.
Results: The incidence was 60.6 per 100.000 person-years for out-of-hospital cardiac arrest and 41.3 per 100.000 person-years for in-hospital cardiac arrest. Survival to hospital discharge was 16.2% for in-hospital cardiac arrest and 16.8% for out-ofhospital cardiac arrest. Pooled mortality from cardiac arrest in our community was 85.0 per 100.000 person-years. Four years after cardiac arrest, 29% of patients had mild cognitive impairment. Restricted mean survival time increased by 57 days as a result of targeted temperature management. Standardised mortality ratio was 2.8 for cardiac arrest survivors over the first four years following hospital discharge, compared with an age- and gender-matched normal population.
Conclusion: Survival to hospital discharge was similar between in-hospital and outof- hospital cardiac arrest. The majority of cardiac arrests occurred out-of-hospital. Nearly one-third of patients with good cerebral outcome on hospital discharge had mild cognitive impairment four years after cardiac arrest. Targeted temperature management increased survival after cardiac arrest.