Impact of chronic obstructive pulmonary disease on survival and neurologic outcomes in adults with in-hospital cardiac arrest.

BACKGROUND: Little data exists regarding the association of chronic obstructive pulmonary disease (COPD) on outcomes in the setting of in-hospital cardiac arrest (IHCA). We sought to assess the impact of COPD on mortality and neurologic outcomes in adults with IHCA. METHODS: The study population included 593 consecutive hospitalized patients with IHCA undergoing ACLS-guided resuscitation at an academic tertiary medical center from 2012-2018. The primary and secondary outcomes of interest were survival to discharge and favorable neurological outcome (defined as a Glasgow Outcome Score of 4-5) respectively. RESULTS: Of the 593 patients studied, 162 (27.3%) had COPD while 431 (72.7%) did not. Patients with COPD were older, more often female, and had higher Charlson Comorbidity score. Location of cardiac arrest, initial rhythm, duration of cardiopulmonary resuscitation, and rates of defibrillation and return of spontaneous circulation were similar in both groups. Patients with COPD had significantly lower rates of survival to discharge (10.5% vs 21.6%, p = 0.002) and favorable neurologic outcomes (7.4% vs 15.9%, p = 0.007). In multivariable analyses, COPD was independently associated with lower rates of survival to discharge [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.30-0.98, p = 0.041]. CONCLUSIONS: In this contemporary prospective registry of adults with IHCA, COPD was independently associated with significantly lower rates of survival to discharge.

Association of post-resuscitation inflammatory response with favorable neurologic outcomes in adults with in-hospital cardiac arrest.

BACKGROUND: Early prediction of mortality in adults after in-hospital cardiac arrest (IHCA) remains vital to optimizing treatment strategies. Inflammatory cytokines specific to early prognostication in this population have not been well studied. We evaluated whether novel inflammatory cytokines obtained from adults with IHCA helped predict favorable neurologic outcome. METHODS: The study population included adults with IHCA who underwent ACLS-guided resuscitation between March 2014 and May 2019 at an academic tertiary medical center. Peripheral blood samples were obtained within 6, 24, 48, 72, and 96 h of IHCA and analysis of 15 cytokines were performed. The primary outcome of interest was presence of favorable neurologic outcome at hospital discharge, defined as a Glasgow Outcome Score of 4 or 5. RESULTS: Of the 105 adults with IHCA studied, 27 (25.7%) were noted to have survival with a favorable neurologic outcome while 78 (74.3%) did not. Patients who survived with favorable neurologic outcome were more often men (88.9% vs 61.5%, p = 0.008) and had higher rates of ventricular tachyarrhythmias as their initial rhythm (34.6% vs 11.7%, p = 0.018). Levels of interleukin (IL)-6, IL-8, IL-10, and Tumor Necrosis Factor (TNF)-R1 within 6 or 24 h were significantly lower in patients with favorable neurologic outcome compared with those who had unfavorable neurologic outcome. In multivariable analysis, IL-10 levels within 6 h was the only independent predictor of favorable neurologic outcomes [odds ratio (OR) 0.895, 95% confidence interval 0.805-0.996, p = 0.041]. CONCLUSION: In this contemporary observational study of adults with IHCA receiving ACLS-guided resuscitative and post-resuscitative care, inflammatory cytokines specific to early prognostication in adults with IHCA exist. Further larger scale studies examining the association of these inflammatory cytokines with prognosis are warranted.

Association between sex and mortality in adults with in-hospital and out-of-hospital cardiac arrest: A systematic review and meta-analysis.

OBJECTIVES: Conflicting data exists regarding the association between sex and mortality in adults with in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA). We therefore conducted a meta-analysis to investigate the association between sex and mortality in adults with IHCA and OHCA. METHODS: We systematically searched MEDLINE and Cochrane databases to identify studies reporting sex-specific mortality in adults following IHCA or OHCA from inception to April 2020. Data were pooled using random-effects models. The primary outcome of interest was in-hospital (or 30-day) all-cause mortality. RESULTS: We included 21 observational studies with a total of 1,029,978 adult patients - 622,085 men and 407,893 women. Seven studies included patients only with IHCA and 14 studies included patients only with OHCA. Female sex was associated with significantly higher mortality following OHCA [odds ratio (OR) 1.56, 95% confidence interval (CI) 1.32-1.84, p < 0.001) and a trend toward higher mortality following IHCA (OR 1.10, 95%CI 1.00-1.20, p = 0.052). CONCLUSIONS: In adults with cardiac arrest, female sex was associated with significantly higher mortality following OHCA and a trend toward higher mortality following IHCA.

Impact of Sex on Survival and Neurologic Outcomes in Adults With In-Hospital Cardiac Arrest.

Data regarding the impact of sex on clinical outcomes in adults with in-hospital cardiac arrest (IHCA) have yielded conflicting results. We aimed to study the impact of female sex on mortality and poor neurologic outcomes in adults with IHCA. The study population included 680 consecutive patients hospitalized with IHCA who underwent ACLS-guided resuscitation from 2012 to 2018 at an academic tertiary medical center. The primary outcome of interest was in-hospital mortality. Secondary outcome of interest was favorable neurological outcome, defined as a Glasgow Outcome Score of 4 or 5. Of the 680 patients studied, 418 (61.5%) were men and 262 (38.5%) were women. Women had lower rates of coronary artery disease, previous myocardial infarction, and peripheral artery disease, and higher rates of chronic obstructive pulmonary disease and depression. Although location of cardiac arrest, initial rhythm, and duration of cardiopulmonary resuscitation were similar in both groups, women had lower rates of defibrillation. Rates of return of spontaneous circulation and receipt of targeted temperature management were similar in men and women. With respect to outcomes, women were noted to have significantly higher rates of in-hospital mortality (87.5% vs 78.0%; p = 0.001) and lower rates of favorable neurologic outcome (10.0% vs 15.8%, p = 0.030) compared with men. In multivariable analyses, female sex was independently associated with nearly two-fold higher rates of in-hospital mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.22-3.04, p = 0.005] and a trend toward lower rates of favorable neurologic outcome (OR 0.63, 95% CI 0.38-1.04, p = 0.071). In conclusion, in this prospective, contemporary registry of adults with IHCA, female sex was independently associated with nearly twofold higher rates of in-hospital mortality and a trend toward lower rates of favorable neurologic outcomes.

Impact of Extracorporeal Membrane Oxygenation on Mortality in Adults With Cardiac Arrest.

Previous studies regarding benefit of extracorporeal membrane oxygenation (ECMO) in adults with cardiac arrest have yielded conflicting results. We aimed to determine whether ECMO in adults hospitalized with cardiac arrest is associated with improved survival compared with conventional cardiopulmonary resuscitation in a nationally representative sample. The U.S. Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (2006 to 2014) was utilized to identify a cohort of adults hospitalized with cardiac arrest at ECMO-capable facilities (defined by the presence of at least 1 ECMO procedure at the facility during the study period of 2006 to 2014). In-hospital mortality was compared between the ECMO and non-ECMO groups using generalized estimating equations with and without coarsened exact matching analysis. Of 273,690 hospitalizations for adults with cardiac arrest, 33,274 occurred at 363 ECMO-capable facilities, of which 775 (2.3%) involved the use of ECMO. There was no significant difference in in-hospital mortality between patients who received ECMO versus those who did not (60.1% vs 57.2%, p = 0.106). In the risk-adjusted analysis, the presence of ECMO was associated with higher rates of in-hospital mortality in the overall sample [odds ratio 1.59, 95% confidence interval 1.37 to 1.85] and the coarsened exact matching sample (n = 1,068 with 534 adults in each group; odds ratio 1.47, 95% confidence interval 1.14 to 1.88). In this cohort of hospitalizations for cardiac arrest at ECMO-capable centers in the U.S., adults who received ECMO had significantly higher mortality than those who did not receive ECMO. Large scale, adequately powered, randomized controlled trials are warranted to assess the benefit of ECMO in cardiac arrest.