In-hospital survival after out-of-hospital cardiac arrest in Carinthia, Austria
DOI:
https://doi.org/10.31247/agnj.v2iS1.47Keywords:
OHCA, retrospective analysis, in-hospital survival, CarinthiaAbstract
Aims of the study: The survival after an out-of-hospital cardiac arrest (OHCA) event depends on the timing and quality of cardiopulmonary resuscitation (CPR) measures. Some factors associated with a favourable outcome are defined but regional differences do not allow a generalization. This analysis reflects the situation of Carinthia, Austria.
Methods: The clinical course of all OHCA survivors of the year 2018 treated by the emergency medical services (EMS) operated by the Austrian Red Cross Carinthia and the Air Rescue Austria (ARA) was followed by a retrospective analysis of the regional clinical information system.
Results: In total, 441 OHCA events were identified, from which 149 patients were transported to a hospital. Clinical data of 125 cases was accessible. From these, 30 patients survived with a favourable neurological outcome, two patients had a persistent vegetative state, and 93 patients did not survive the hospital stay. Those patients who survived were younger (p = 0.012), received a shorter duration of CPR measures (p < 0.01), had lower blood levels of lactate (p < 0.01), higher blood pH (p < 0.01), and lower serum levels of the neuron specific enolase (NSE; p = 0.031). Factors that were not associated with survival were preclinical arrival time of the advanced life support team (p = 0.317), the presence of a bystander during the OHCA event (p = 0.415), or blood levels of oxygen (p = 0.684) or carbon dioxide (p = 0.296). None of the patients transported during CPR survived.
Conclusion: Patients who primarily survive an OHCA event show a clinical survival rate of approximately 25 % in Carinthia. Age, duration of CPR, and blood levels of lactate, pH, and NSE levels are associated with survival.
Total
(n = 125)
Survivors
(n = 32)
Dead
(n = 93)
p
Age [median (IQR); years]
71 (59-81)
64 (56-75)
72 (61-82)
0.012
Female sex [%]
31
25
33
0.388
Arrival time of ALS team [median (IQR); minutes]
9 (7-14)
11 (8-15)
8 (6-12)
0.317
Duration of CPR [median (IQR); minutes]
15 (9-30)
10 (2-11)
23 (10-36)
<0.001
Bystander-CPR [%]
47
53
45
0.415
Transport during CPR [n]
28
0
28
-
Blood lactate levels [median (IQR); mmol/l]
7.4 (4.1-12.5)
3.3 (2.3-5.8)
9.9 (5.9-13.7)
<0.001
Blood pH level [median (IQR)]
7.1 (7.0-7.2)
7.3 (7.1-7.3)
7.1 (7.0-7.2)
<0.001
Blood arterial oxygen level [median (IQR); mmHg]
102 (64-173)
107 (62-185)
97 (65-173)
0.684
Blood arterial carbon dioxide level [median (IQR); mmHg]
55 (44-68)
50 (43-66)
57 (45-69)
0.296
Blood neuron specific enolase level [median (IQR); µg/l]
48 (29-95)
22 (17-60)
54 (33-112)
0.031
ECMO use [n]
4
0
4
-
Induced hypothermia [%]
44
44
44
0.107
Suspected primary cause of OHCA
Thromboembolic event [%]
29
44
24
Hypoxia [%]
20
34
15
Hypo- / Hyperkalemia [%]
2
3
1
Hypovolemia [%]
0.8
0
1
Pneumothorax [%]
0.8
0
1
Intoxication [%]
0.8
0
1
Malign arrhythmia [%]
6
19
2
Unknown [%]
51
0
54