Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study

Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study

OBJECTIVES:. Data on cardiac arrest survivors from developing countries are scarce. This study investigated clinical characteristics associated with in-hospital mortality in resuscitated patients following cardiac arrest in Brazil. DESIGN:. Retrospective analysis of prospectively collected data. SET...

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Autores principales: Pedro Kurtz, MD, Christian Storm, MD, Marcio Soares, MD, Fernando Bozza, MD, Carolina B. Maciel, MD, David M. Greer, MD, Leonardo S. L. Bastos, MSc, Ulisses Melo, MD, Bruno Mazza, MD, Marcelo S. Santino, MD, Roberto Seabra Lannes, MD, Ana Paula Pierre de Moraes, MD, Joel Tavares Passos, MD, Giulliana Martines Moralez, MD, Robson Correa Santos, MD, Maristela Medeiros Machado, MD, Saulo Fernandes Saturnino, MD, Ciro Leite Mendes, MD, Arthur Oswaldo Vianna, MD, Jorge Salluh, MD, on behalf of the ORCHESTRA Study Investigators, Maristela Medeiros Machado, Luciano Ferreira de Souza, Rubens Antônio Bento Ribeiro, Eduardo Cesar Guimarães Lessa, Clayton Barbieri de Carvalho, Tullio Xavier Leirias, Marcelo de Oliveira Maia, Edmilson Leal Bastos, Rebeca Martins da Silva Barros, Cintya M.V. Oliveira, Jose Aires A Neto, Eliana Bernadete Caser, Silvane Damasceno, Marcelo Rabahi Fouad, Marco Antônio Mendes Castilho, Durval Ferreira Fonseca Pedroso, Humberto Borges Barbosa, Ana Paula Pierre de Moraes, Ana Cláudia Pinho de Carvalho, Alexandre Guilherme Ribeiro de Carvalho, Akemy Carvalho do Rosário, Marcelo Ferreira Sousa, Marcia Maria Ferreira de Souza, Saulo Fernandes Saturnino, Ciro Leite Mendes, Paulo César Gottardo, Igor Mendonça do Nascimento, Mariza da Fonte Andrade Lima, Marçal Paiva, Carlos Eduardo Ferraz Freitas, Lanecley Gouveia Neves Fulco, Maurício Magalhães Cabral, Luciane Ishiy, Renato Fábio Alberto Della Santa Neto, Giulliana Martines Moralez, Flavio Callil, Claudio Eduardo Calife Chagas, Eliane Casanova, Antonio Carlos Babo Rodrigues, Bruno Vidal, Arthur O. A. Vianna, Patrícia Soares D’Alessandro, Robson Correa Santos, Ricardo Pessoa Martelo, Rodrigo Barros, Luisa Chuairi, Roberto Costa, Cristiane Belo, Giulia P. C. Lima, Cristiane Cariús, Eduardo Xavier, Claudia Lourenço de Almeida, Rafael Sibanto, Alessandra Longo, Joyce Roma, Juliana Gurgel da Silveira, Laura Brasil Herranz, Gustavo Vaz, Bruno Cartelo Branco, Leonardo Campioni, Alexandre Coscia, Walter Homena, Marcelo de Sousa Santino, Juan Carlos Verdeal, William Nascimento Viana e Lígia Sarmet Farah Cunha Rabello, Janaína Oliveira, Cecília Magno, Alex Gaspar, Guilherme Feres, Maria Teresa Saint-Martin, Eric Perecmanis, Jorge Eduardo da Silva Soares Pinto, Sergio Teixeira Sant’Anna Junior, Guilherme Brenande Alves Faria, Alcino Márcio Toledo de Medeiros, Márcia Adélia de Magalhães Menezes, Rosa Imaculada Stancato, Joyce Andrade, Alessandra Alves, Alexandre Vaz Scotti, Roberto Seabra Lannes, Sion Divan Filho, Andrea Ludovico, Marcos Knibel, Emir Oliveira, Pedro Azambuja, Aline Affonso, Joel Tavares Passos, Carlos Cesar Hortala Junior, Edmundo de Oliveira Tommasi, Patricia Frascari Litrento, Alexandra Gonçalves da Silva, Henrique Miller Balieiro, Fellipe de Freitas Pereira, Ulisses de Oliveira Melo, Edson Tristão, Kelsey Sampaio, Rogerio Silveira, Antonio Carlos, Felipe Mafort, Jose Hipólito, Valquíria Queiroz, Bruno Azevedo da Cruz, Karla Biancha Silva de Andrade, Thiago Lisboa, André P. Torelly, Daniella Birriel, Edison Moraes Rodrigues Filho, José Pettine, Moreno Calcagnotto dos Santos, Tiago Almeida Ramos, Fernando Bourscheit, Ana Flávia Gallas Leivas, Marcus Antonio Ferez, Edson Antonio Nicolini, Fernando Vinicius Cesar De Marco, Guilherme Paro de Toledo, Ulysses V. Andrade e Silva, Cristina Prata Amendola, Fernando Colombari, Thiago Domingos Corrêa, Eliézer Silva, José Mauro Vieira, Jr, Luciano Azevedo, Fernando Ramos, Silvia Regina Ramos, Lilian Mara Perroud Miilher, Flávio Geraldo Rezende de Freitas, Antônio Tonete Bafi, Eduardo Souza Pacheco, Dieter Eduardo Siefeld Araya, Ronaldo Escudeiro Borba, Moacyr Fogolin Junior, Pedro Ivo Buainain, Mariza Luciana Pregun, José Albani Carvalho, Jr, Mariza Silva Ramos Loesch, Kassia Pinho, Bruno Franco Mazza, Samantha Longhi de Almeida, Rosa Goldstein Alheira Rocha, Edson Romano, Fernando Zampieri, Carlos Eduardo Nassif Moreira, Bruno Adler Maccagnan Pinheiro Besen, Carlos Eduardo Brandão
Formato: article
Lenguaje:EN
Publicado: Wolters Kluwer 2021
Materias:
Medical emergencies. Critical care. Intensive care. First aid
RC86-88.9
Acceso en línea:https://doaj.org/article/f47d8e08af8746da8585f3a9c550e2aa
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Descripción
Sumario:OBJECTIVES:. Data on cardiac arrest survivors from developing countries are scarce. This study investigated clinical characteristics associated with in-hospital mortality in resuscitated patients following cardiac arrest in Brazil. DESIGN:. Retrospective analysis of prospectively collected data. SETTING:. Ninety-two general ICUs from 55 hospitals in Brazil between 2014 and 2015. PATIENTS:. Adult patients with cardiac arrest admitted to the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We analyzed 2,296 patients (53% men; median 67 yr (interquartile range, 54–79 yr]). Eight-hundred patients (35%) had a primary admission diagnosis of cardiac arrest suggesting an out-of-hospital cardiac arrest; the remainder occurred after admission, comprising an in-hospital cardiac arrest cohort. Overall, in-hospital mortality was 83%, with only 6% undergoing withholding/withdrawal-of-life support. Random-effects multivariable Cox regression was used to assess associations with survival. After adjusting for age, sex, and severity scores, mortality was associated with shock (adjusted odds ratio, 1.25 [95% CI, 1.11–1.39]; p < 0.001), temperature dysregulation (adjusted odds ratio for normothermia, 0.85 [95% CI, 0.76–0.95]; p = 0.007), increased lactate levels above 4 mmol/L (adjusted odds ratio, 1.33 [95% CI, 1.1–1.6; p = 0.009), and surgical or cardiac cases (adjusted odds ratio, 0.72 [95% CI, 0.6–0.86]; p = 0.002). In addition, survival was better in patients with probable out-of-hospital cardiac arrest, unless ICU admission was delayed (adjusted odds ratio for interaction, 1.63 [95% CI, 1.21–2.21]; p = 004). CONCLUSIONS:. In a large multicenter cardiac arrest cohort from Brazil, we found a high mortality rate and infrequent withholding/withdrawal of life support. We also identified patient profiles associated with worse survival, such as those with shock/hypoperfusion and arrest secondary to nonsurgical admission diagnoses. Our findings unveil opportunities to improve postarrest care in developing countries, such as prompt ICU admission, expansion of the use of targeted temperature management, and implementation of shock reversal strategies (i.e., early coronary angiography), according to modern guidelines recommendations.

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