Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2021 |
| Outros Autores: | , , , , , , , , , , , , , , , , , , |
| Tipo de documento: | Artigo |
| Idioma: | eng |
| Título da fonte: | Repositório Institucional da FIOCRUZ (ARCA) |
| Texto Completo: | https://www.arca.fiocruz.br/handle/icict/50540 |
Resumo: | Instituto Estadual do Cérebro Paulo Niemeyer. Departamento de Neurointensiva. Rio de Janeiro, RJ, Brasil / Hospital Copa Star. Departamento de Terapia Neurointensiva. Rio de Janeiro, RJ, Brasil. |
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Kurtz, PedroStorm, ChristianSoares, MarcioBozza, FernandoMaciel, Carolina B.Greer, David M.Bastos, Leonardo S. L.Melo, UlissesMazza, BrunoSantino, Marcelo S.Lannes, Roberto SeabraMoraes, Ana Paula Pierre dePassos, Joel TavaresMoralez, Giulliana MartinesSantos, Robson CorreaMachado, Maristela MedeirosSaturnino, Saulo FernandesMendes, Ciro LeiteVianna, Arthur OswaldoSalluh, Jorge2021-12-28T14:18:01Z2021-12-28T14:18:01Z2021KURTZ, Pedro et al. Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study. Critical care explorations, v. 3, n. 7, p. 1-11, 20212639-8028https://www.arca.fiocruz.br/handle/icict/5054010.1097/CCE.0000000000000479engWolters Kluwer HealthClinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Studyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleInstituto Estadual do Cérebro Paulo Niemeyer. Departamento de Neurointensiva. Rio de Janeiro, RJ, Brasil / Hospital Copa Star. Departamento de Terapia Neurointensiva. Rio de Janeiro, RJ, Brasil.Charité-Universitätsmedizin Berlin. Departamento de Nefrologia e Terapia Intensiva. Berlin, Germany.Instituto D'Or de Pesquisa e Educação. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil / Instituto D'Or de Pesquisa e Educação. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil.University of Florida College of Medicine. Department of Neurology. Gainesville, FL, USA.Boston University School of Medicine. Department of Neurology. Boston, MA, USA.Pontifícia Universidade Católica do Rio de Janeiro. Departamento de Engenharia Industrial. Rio de Janeiro, RJ, Brasil.Hospital Estadual Alberto Torres. UTI. São Gonçalo, SP, Brasil.Hospital Samaritano. UTI. São Paulo, SP, Brasil.Hospital Barra D'Or. UTI. Rio de Janeiro, RJ, Brasil.Hospital Municipal Souza Aguiar. UTI. Rio de Janeiro, RJ, Brasil.Hospital de Câncer do Maranhão Tarquínio Lopes Filho. UTI. São Luís, MA, Brasil.Hospital Unimed Costa do Sol. UTI. Macaé, RJ, Brasil.Hospital Estadual Getúlio Vargas. UTI. Rio de Janeiro, RJ, Brasil.Hospital Estadual Adão Pereira Nunes. UTI. Duque de Caxias, RJ, Brasil / Hospital Estadual Carlos Chagas. UTI. Rio de Janeiro, RJ, Brasil.Hospital Agenor Paiva. UTI. Salvador, BA, Brasil.Universidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Emergência. UTI. Belo Horizonte, MG, Brasil.Hospital Universitário Lauro Wanderley. UTI. João Pessoa, PB, Brasil.Clínica São Vicente. UTI. Rio de Janeiro, RJ, Brasil.Instituto D'Or de Pesquisa e Educação. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil.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.Cardiac arrestCritical careHeart arrestOutcomes assessmentTargeted temperature managementTherapeutic hypothermiainfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83099https://www.arca.fiocruz.br/bitstream/icict/50540/1/license.txt586c046dcfeef936e32f0323bb9a47c0MD51ORIGINALClinical Characteristics_Fernando_Bozza_etal_INI_2021.pdfClinical 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| dc.title.pt_BR.fl_str_mv |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study |
| title |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study |
| spellingShingle |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study Kurtz, Pedro Cardiac arrest Critical care Heart arrest Outcomes assessment Targeted temperature management Therapeutic hypothermia |
| title_short |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study |
| title_full |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study |
| title_fullStr |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study |
| title_full_unstemmed |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study |
| title_sort |
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study |
| author |
Kurtz, Pedro |
| author_facet |
Kurtz, Pedro Storm, Christian Soares, Marcio Bozza, Fernando Maciel, Carolina B. Greer, David M. Bastos, Leonardo S. L. Melo, Ulisses Mazza, Bruno Santino, Marcelo S. Lannes, Roberto Seabra Moraes, Ana Paula Pierre de Passos, Joel Tavares Moralez, Giulliana Martines Santos, Robson Correa Machado, Maristela Medeiros Saturnino, Saulo Fernandes Mendes, Ciro Leite Vianna, Arthur Oswaldo Salluh, Jorge |
| author_role |
author |
| author2 |
Storm, Christian Soares, Marcio Bozza, Fernando Maciel, Carolina B. Greer, David M. Bastos, Leonardo S. L. Melo, Ulisses Mazza, Bruno Santino, Marcelo S. Lannes, Roberto Seabra Moraes, Ana Paula Pierre de Passos, Joel Tavares Moralez, Giulliana Martines Santos, Robson Correa Machado, Maristela Medeiros Saturnino, Saulo Fernandes Mendes, Ciro Leite Vianna, Arthur Oswaldo Salluh, Jorge |
| author2_role |
author author author author author author author author author author author author author author author author author author author |
| dc.contributor.author.fl_str_mv |
Kurtz, Pedro Storm, Christian Soares, Marcio Bozza, Fernando Maciel, Carolina B. Greer, David M. Bastos, Leonardo S. L. Melo, Ulisses Mazza, Bruno Santino, Marcelo S. Lannes, Roberto Seabra Moraes, Ana Paula Pierre de Passos, Joel Tavares Moralez, Giulliana Martines Santos, Robson Correa Machado, Maristela Medeiros Saturnino, Saulo Fernandes Mendes, Ciro Leite Vianna, Arthur Oswaldo Salluh, Jorge |
| dc.subject.en.pt_BR.fl_str_mv |
Cardiac arrest Critical care Heart arrest Outcomes assessment Targeted temperature management Therapeutic hypothermia |
| topic |
Cardiac arrest Critical care Heart arrest Outcomes assessment Targeted temperature management Therapeutic hypothermia |
| description |
Instituto Estadual do Cérebro Paulo Niemeyer. Departamento de Neurointensiva. Rio de Janeiro, RJ, Brasil / Hospital Copa Star. Departamento de Terapia Neurointensiva. Rio de Janeiro, RJ, Brasil. |
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2021 |
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2021-12-28T14:18:01Z |
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2021-12-28T14:18:01Z |
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2021 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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KURTZ, Pedro et al. Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study. Critical care explorations, v. 3, n. 7, p. 1-11, 2021 |
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https://www.arca.fiocruz.br/handle/icict/50540 |
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2639-8028 |
| dc.identifier.doi.none.fl_str_mv |
10.1097/CCE.0000000000000479 |
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KURTZ, Pedro et al. Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study. Critical care explorations, v. 3, n. 7, p. 1-11, 2021 2639-8028 10.1097/CCE.0000000000000479 |
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Wolters Kluwer Health |
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Wolters Kluwer Health |
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