Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management

Figures & data

Table 1 Baseline characteristics of OHCA and IHCA patients treated with targeted temperature management

Characteristics	OHCA n=233 (83%)	IHCA n= 49 (17%)	P-value
Male, n (%)	182 (78)	37 (76)	0.691
Age, years, median (IQR)	64 (55–73)	64 (57–74)	0.761
BMI, median (IQR)	25 (23–28)	26 (24–29)	0.135
Initial rhythm, n (%)
VF	168 (72)	19 (39)	<0.001
pVT	13 (6)	2 (4)
Asystole	23 (10)	16 (33)
PEA	22 (9)	7 (14)
Unknown	7 (3)	5 (10)
Pre-arrest cardiovascular comorbidity, n (%)
Diabetes	29 (12)	5 (10)	0.661
Hypertension	70 (30)	21 (43)	0.081
Hypercholesterolemia	32 (14)	7 (14)	0.919
Ischemic heart disease	51 (22)	11 (22)	0.931
CPR by bystander, n (%)	145 (62)	49 (100)	<0.001
Time to ROSC (min), median (IQR)	15 (10–23)	10 (6–15)	<0.001
Etiology of cardiac arrest
STEMI, n (%)	122 (52)	17 (35)	0.054
NSTEMI, n (%)	24 (10)	5 (10)
Primary arrhythmia, n (%)	44 (19)	10 (20)
Noncardiac, n (%)	43 (18)	17 (35)
Acute CAG, n (%)	156 (67)	25 (51)	0.034
Primary PCI, n (%)	102 (44)	18 (37)	0.516
IABP, n (%)	21 (9)	7 (14)	0.262
Temporary pacemaker, n (%)	34 (15)	13 (27)	0.042
Vasoactive drugs, n (%)
Epinephrine*	35 (15)	13 (27)	0.051
Other vasoactive drugs	182 (78)	32 (65)	0.057
No vasoactive drugs	16 (7)	4 (8)	0.748
Length of admission, median days (IQR)
At ICU	4 (3–7)	4 (2–8)	0.534
In total	8 (5–12)	8 (3–12)	0.440
Survival to hospital discharge, n (%)	125 (54)	26 (53)	0.940
CPC 1–2 at hospital discharge	107 (86)	24 (92)	0.829

Note:

* Epinephrine given along with other vasoactive drugs.

Abbreviations: BMI, body mass index; CAG, coronary arteriography; CPC, cerebral performance categories; CPR, cardiopulmonary resuscitation; IABP, intra-aortic balloon pump; ICU, intensive care unit; IHCA, in-hospital cardiac arrest; IQR, interquartile range; OHCA, out-of-hospital cardiac arrest; PCI, percutaneous coronary intervention; PEA, pulseless electrical activity; pVT, pulseless ventricular tachycardia; ROSC, return of spontaneous circulation; STEMI, ST segment elevation myocardial infarction; NSTEMI, non-segment elevation myocardial infarction; VF, ventricular fibrillation.

Table 2 Logistic regression analysis of variables associated with survival to hospital discharge in OHCA and IHCA patients treated with targeted temperature management

Characteristics	Survivors N=151 (%)	Unadjusted OR (95% CI)	Adjusted OR** (95% CI)
Cardiac arrest site
IHCA	26 (17)	0.98 (0.53–1.81)	0.98 (0.43–2.24)
OHCA	125 (83)	1 (ref)	1 (ref)
Gender
Male	123 (81)	1.60 (0.91–2.82)	1.24 (0.64–2.37)
Female	28 (19)	1 (ref)	1 (ref)
Age
≤60 years	73 (48)	3.20 (1.91–5.35)	3.33 (1.86–5.95)
>60 years	78 (52)	1 (ref)	1 (ref)
CPR by bystander
CPR by bystander	111 (74)	1.97 (1.15–3.38)	2.42 (1.28–4.55)
No bystander	40 (26)	1 (ref)	1 (ref)
Time to ROSC
ROSC ≤10 min	66 (44)	2.58 (1.53–4.36)	3.63 (1.94–6.76)
ROSC >10 min	85 (56)	1 (ref)	1 (ref)
Initial rhythm
Shockable	129 (85)	5.59 (3.01–10.40)	6.14 (2.88–13.09)
Non-shockable	16 (11)	1 (ref)	1 (ref)
Unknown***	6 (4)	0.87 (0.27–2.78)	1.98 (0.49–7.98)
Etiology of cardiac arrest
STEMI	86 (57)	1.97 (1.22–3.18)	1.28 (0.73–2.26)
Other etiology****	65 (43)	1 (ref)	1 (ref)

Notes:

** Adjusted for site of cardiac arrest (IHCA vs OHCA), gender (male vs female), age (≤60 years vs >60 years), CPR by bystander (yes vs no), time to ROSC (≤10 vs >10 min), initial rhythm (shockable vs non-shockable vs unknown), and etiology of cardiac arrest (STEMI vs etiology other than STEMI).

*** Unknown initial rhythm.

**** Other etiology: non-STEMI, primary arrhythmia, and noncardiac causes.

Abbreviations: CI, confidence interval; CPR, cardiopulmonary resuscitation; IHCA, in-hospital cardiac arrest; OHCA, out-of-hospital cardiac arrest; OR, odds ratio; ref, reference; ROSC, return of spontaneous circulation; STEMI, ST segment elevation myocardial infarction.

Figure 1 Kaplan–Meier curves illustrating cumulative long-term survival in OHCA and IHCA patients treated with targeted temperature management.

Abbreviations: IHCA, in-hospital cardiac arrest; OHCA, out-of-hospital cardiac arrest.

Table 3 Baseline characteristics of OHCA and IHCA patients treated with targeted temperature management who survived to hospital discharge

Characteristics	OHCA n=125	IHCA n= 26	P-value
Male, n (%)	102 (82)	21 (81)	0.921
Age, years, median (IQR)	61 (53–69)	61 (54–73)	0.536
Initial rhythm, n (%)
VF	105 (84)	14 (54)	0.001
pVT	9 (7)	1 (4)
Asystole	4 (3)	4 (15)
PEA	4 (3)	4 (15)
Unknown	3 (2)	2 (8)
Pre-arrest comorbidity, n (%)
Diabetes	9 (7)	0 (0)	0.158
Hypertension	38 (30)	11 (42)	0.238
Hypercholesterolemia	13 (10)	3 (12)	0.864
Ischemic heart disease	24 (19)	3 (12)	0.354
CPR by bystander, n (%)	87 (70)	26 (100)	0.001
Time to ROSC (min), median (IQR)	14 (8–20)	10.5 (6–17)	0.186
Etiology of cardiac arrest
STEMI, n (%)	72 (58)	14 (54)	0.725
NSTEMI, n (%)	14 (11)	2 (8)
Primary arrhythmia, n (%)	24 (19)	7 (27)
Noncardiac, n (%)	15 (12)	3 (12)
Acute CAG, n (%)	90 (72)	18 (69)	0.776
Primary PCI, n (%)	61 (49)	13 (50)	0.911
Vasoactive drugs, n (%)
Epinephrine*	8 (6)	5 (19)	0.034
Other vasoactive drugs	105 (84)	19 (73)	0.186
No vasoactive drugs	12 (10)	2 (8)	0.760
IABP, n (%)	11 (9)	4 (15)	0.307
Temporary pacemaker, n (%)	14 (11)	7 (27)	0.035
Length of hospital stay, median days (IQR)	11 (6–16)	9 (5–15)	0.189
CPC 1–2 at hospital discharge	106 (85)	24 (92)	0.642

Note:

* Epinephrine given along with other vasoactive drugs

Abbreviations: CAG, coronary arteriography; CPC, cerebral performance categories; CPR, cardiopulmonary resuscitation; IABP, intra-aortic balloon pump; IHCA, in-hospital cardiac arrest; IQR, interquartile range; OHCA, out-of-hospital cardiac arrest; PCI, percutaneous coronary intervention; PEA, pulseless electrical activity; pVT, pulseless ventricular tachycardia; ROSC, return of spontaneous circulation; STEMI, ST segment elevation myocardial infarction; NSTEMI, non-segment elevation myocardial infarction; VF, ventricular fibrillation.

Table 4 Univariate and multivariate Cox regression analysis of factors associated with long-term survival after hospital discharge in OHCA and IHCA patients treated with targeted temperature management

Characteristics	Survivors N=151 (%)	Unadjusted HR (95% CI)	Adjusted HR** (95% CI)
Cardiac arrest site
IHCA	26 (17)	0.81 (0.37–1.76)	1.51 (0.59–3.91)
OHCA	125 (83)	1 (ref)	1 (ref)
Gender
Male	123 (81)	1.33 (0.61–2.90)	1.24 (0.5–2.77)
Female	28 (19)	1 (ref)	1 (ref)
Age
≤60 years	73 (48)	2.42 (1.22–4.76)	2.73 (1.36–5.52)
>60 years	78 (52)	1 (ref)	1 (ref)
CPR by bystander
CPR by bystander	111 (74)	1.00 (0.46–2.16)	0.92 (0.41–2.06)
No bystander	40 (26)	1 (ref)	1 (ref)
Time to ROSC
ROSC ≤10 min	66 (44)	0.83 (0.44–1.56)	1.06 (0.54–2.10)
ROSC >10 min	85 (56)	1 (ref)	1 (ref)
Initial rhythm
Shockable	129 (85)	1.85 (0.72–4.72)	1.89 (0.68–5.24)
Non-shockable	16 (11)	1 (ref)	1 (ref)
Unknown***	6 (4)	0.61 (0.15–2.44)	0.42 (0.10–1.75)
Etiology of cardiac arrest
STEMI	86 (57)	1.66 (0.88–3.12)	1.25 (0.63–2.45)
Other etiology ****	65 (43)	1 (ref)	1 (ref)

Notes:

** Adjusted for site of cardiac arrest (IHCA vs OHCA), gender (male vs female), age (≤60 years vs >60 years), CPR by bystander (yes vs no), time to ROSC (≤10 vs >10 min), initial rhythm (shockable vs non-shockable vs unknown), and etiology of cardiac arrest (STEMI vs etiology other than STEMI).

*** Unknown initial rhythm.

**** Other etiology: non-STEMI, primary arrhythmia, and noncardiac causes.

Abbreviations: CI, confidence interval; CPR, cardiopulmonary resuscitation; HR, hazard ratio; IHCA, in-hospital cardiac arrest; OHCA, out-of-hospital cardiac arrest; ref, reference; ROSC, return of spontaneous circulation; STEMI, ST segment elevation myocardial infarction.