Clinical characteristics and in-hospital mortality of cardiac arrest survivors in Brazil: a large retrospective multicenter cohort study

• Autor(a) principal: Pedro Martins Pereira Kurtz
• Data de Publicação: 2021
• Outros Autores: Christian Storm, Márcio Soares, Fernando Augusto Bozza, Carolina B. Maciel, Leonardo dos Santos Lourenço Bastos, Ulisses Melo, Bruno Franco Mazza, Marcelo S. Santino, Roberto Seabra Lannes, Ana Paula Pierre de Moraes, Joel Tavares Passos, Giulliana Martines Moralez, Robson Correa Santos, Maristela Medeiros Machado, Saulo Fernandes Saturnino, Ciro Leite Mendes, Arthur Oswaldo de Abreu Vianna, Jorge Ibrain Figueira Salluh
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: https://doi.org/10.1097/CCE.0000000000000479; http://hdl.handle.net/1843/54675; https://orcid.org/0000-0001-7833-0403; https://orcid.org/0000-0003-4914-2459; https://orcid.org/0000-0002-8999-961X; https://orcid.org/0000-0002-0150-4898; https://orcid.org/0000-0002-8164-1453
• topic: Cardiac arrest; Critical care; Heart arrest; Outcomes assessment; Targeted temperature management; Therapeutic hypothermia; Parada cardíaca; Cuidados críticos; Avaliação de resultados em cuidados de saúde; Hipotermia induzida; Mortalidade hospitalar

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.