SPC365

Survival Clock: Unveiling Mortality Predictors in Out-of-Hospital Cardiac Arrest

Session: Sessão de Posters 04 - Choque cardiogénico
Speaker: Daniel Inácio Cazeiro

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.5 Acute Cardiac Care – Cardiac Arrest
Session Type: Cartazes
FP Number: ---
Authors: Daniel Inácio Cazeiro; Ana Margarida Martins; Catarina Simões de Oliveira; Ana Beatriz Garcia; João Santos Fonseca; João Mendes Cravo; Marta Vilela; Diogo Ferreira; Carolina Robalo; Fausto J. Pinto; João Ribeiro; Doroteia Silva

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Introduction:&nbsp;</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">Out-of-hospital cardiac arrest (OHCA) affects around 3.8 million people annually worldwide. Early initiation of cardiopulmonary resuscitation&nbsp;and prompt access to defibrillators are crucial, but despite improved care systems, mortality remains high. Prognostic indicators like no-flow time (NFT), low-flow time (LFT), and Glasgow Coma Score (GCS) after return to spontaneous circulation (ROSC) are often associated with outcomes, but specific cut-off values are lacking in evidence.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Purpose</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">: to establish a correlation between NFT, LFT and GCS after ROSC and all-cause mortality.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Methods:&nbsp;</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">Retrospective, observational, single-center study on patients admitted to an intensive care unit (ICU)&nbsp;of a tertiary hospital following OHCA between 2017 and 2019. Data was collected from clinical registries, receiving operating characteristic analysis was used to assess the impact of LFT, NFT and GCS after ROSC in predicting all-cause mortality (ACM). Kaplan-Meier survival analysis was performed.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Results:&nbsp;</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">Among the 79 participants considered, 32.9% were female, with a mean age of 59.3&plusmn;15.1 years. The majority of OHCA were witnessed (84.8%), and basic life support was administered in 72.2% of cases. However, only 25.3% of these interventions involved the use of an automated external defibrillator.&nbsp;</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">A total of 59 patients (74.7%) died during follow-up (FUP). Mean FUP time in surviving patients was 3.9 years. Mean NFT was 4.1&plusmn;3.1 minutes and LFT was 22.7&plusmn;12.3 minutes. There was not a correlation between NFT and ACM. However, there was a strong correlation between increasing LFT and ACM. Specifically, the use of a 15-minute cut-off demonstrated the highest sensitivity and specificity in predicting mortality. Patients that face a LFT greater than 15 minutes had 2.1 times the risk of death when compared to patients with LFT of less than 15 minutes (HR: 2.07, CI 95%: 1.124-3.34, p=0.045).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">Median GCS after ROSC was 3. It was found that GCS of 6 was the best cut-off value in terms of sensitivity and specificity to discriminate mortality risk. Patients with a GCS inferior to 6 had a statistically significant greater risk of mortality than patients with a GCS of at least 6 (HR: 4.43, CI 95%: 1.73-11.32, p&lt;0.001).</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff"><strong>Conclusion:&nbsp;</strong></span></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">Our study underscores the importance of time and neurological status in OHCA cases. NFT cannot be used to predict ACM as it is difficult to ascertain. In contrast, a LFT beyond 15 minutes and a GCS below 6 serve as key indicators associated with increased mortality risk.</span></span></span></span></p>