Recurrent out-of-hospital cardiac arrest

Ziad Nehme, Emily Andrew, Resmi Nair, Stephen Bernard, Karen Smith

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Little is known about the burden of recurrent out-of-hospital cardiac arrest (OHCA) episodes in initial survivors of OHCA. We sought to investigate the frequency of recurrent OHCA, describe time-to-event trends, and establish baseline predictors of occurrence. Methods: Between January 2000 and June 2015, we included consecutive OHCA survivors to hospital discharge from the Victorian Ambulance Cardiac Arrest Registry. Patient identifiers were used to match index and recurrent episodes of OHCA, and death records from a government database. Kaplan-Meier curves and a Cox proportional-hazards model were used to estimate the long-term risk of recurrent OHCA and identify index characteristics associated with their occurrence. Results: Among 3581 survivors, 214 (6.0%) experienced a recurrent OHCA over a median time-at-risk of 5.0 years (interquartile range [IQR]: 2.0, 8.1). The median age at recurrent OHCA was 69 years, 72.9% were male, and 92.0% of events were fatal. Fatal recurrent OHCA episodes accounted for more than one-quarter of all deaths at follow-up. The probability of recurrent OHCA at 1, 5, 10 and 15 years was 2.4% (95% CI: 2.0%, 3.0%), 6.0% (95% CI: 5.2%, 6.9%), 8.4% (95% CI: 7.3%, 9.8%), and 11.2% (95% CI: 9.1%, 13.8%), respectively. In the multivariable model, the following baseline predictors were significantly associated with recurrent OHCA: respiratory (HR 1.88, 95% CI: 1.02, 3.47; p = 0.045) or overdose/poisoning aetiology (HR 2.47, 95% CI: 1.08, 5.62; p = 0.03), diabetes (HR 1.92, 95% CI: 1.17, 3.14, p = 0.01), heart failure (HR 2.22, 95% CI: 1.28, 3.85; p = 0.005), and renal insufficiency (HR 2.43, 95% CI: 1.23, 4.82; p = 0.01). The risk of recurrent OHCA did not decline over the study period (per year increase: HR 0.97, 95% CI: 0.93, 1.01; p = 0.13). Conclusion: Recurrent OHCA episodes occur frequently in OHCA survivors, and could account for as many as one-quarter of all deaths at follow-up. Index characteristics may help to identify at-risk patients.

Original languageEnglish
Pages (from-to)158-165
Number of pages8
JournalResuscitation
Volume121
DOIs
Publication statusPublished - Dec 2017

Keywords

  • Emergency medical services
  • Epidemiology
  • Out-of-hospital cardiac arrest
  • Recurrent cardiac arrest
  • Secondary prevention
  • Sudden cardiac death

Cite this

Nehme, Ziad ; Andrew, Emily ; Nair, Resmi ; Bernard, Stephen ; Smith, Karen. / Recurrent out-of-hospital cardiac arrest. In: Resuscitation. 2017 ; Vol. 121. pp. 158-165.
@article{e64397274fd24c18a9bc04f1fc099493,
title = "Recurrent out-of-hospital cardiac arrest",
abstract = "Background: Little is known about the burden of recurrent out-of-hospital cardiac arrest (OHCA) episodes in initial survivors of OHCA. We sought to investigate the frequency of recurrent OHCA, describe time-to-event trends, and establish baseline predictors of occurrence. Methods: Between January 2000 and June 2015, we included consecutive OHCA survivors to hospital discharge from the Victorian Ambulance Cardiac Arrest Registry. Patient identifiers were used to match index and recurrent episodes of OHCA, and death records from a government database. Kaplan-Meier curves and a Cox proportional-hazards model were used to estimate the long-term risk of recurrent OHCA and identify index characteristics associated with their occurrence. Results: Among 3581 survivors, 214 (6.0{\%}) experienced a recurrent OHCA over a median time-at-risk of 5.0 years (interquartile range [IQR]: 2.0, 8.1). The median age at recurrent OHCA was 69 years, 72.9{\%} were male, and 92.0{\%} of events were fatal. Fatal recurrent OHCA episodes accounted for more than one-quarter of all deaths at follow-up. The probability of recurrent OHCA at 1, 5, 10 and 15 years was 2.4{\%} (95{\%} CI: 2.0{\%}, 3.0{\%}), 6.0{\%} (95{\%} CI: 5.2{\%}, 6.9{\%}), 8.4{\%} (95{\%} CI: 7.3{\%}, 9.8{\%}), and 11.2{\%} (95{\%} CI: 9.1{\%}, 13.8{\%}), respectively. In the multivariable model, the following baseline predictors were significantly associated with recurrent OHCA: respiratory (HR 1.88, 95{\%} CI: 1.02, 3.47; p = 0.045) or overdose/poisoning aetiology (HR 2.47, 95{\%} CI: 1.08, 5.62; p = 0.03), diabetes (HR 1.92, 95{\%} CI: 1.17, 3.14, p = 0.01), heart failure (HR 2.22, 95{\%} CI: 1.28, 3.85; p = 0.005), and renal insufficiency (HR 2.43, 95{\%} CI: 1.23, 4.82; p = 0.01). The risk of recurrent OHCA did not decline over the study period (per year increase: HR 0.97, 95{\%} CI: 0.93, 1.01; p = 0.13). Conclusion: Recurrent OHCA episodes occur frequently in OHCA survivors, and could account for as many as one-quarter of all deaths at follow-up. Index characteristics may help to identify at-risk patients.",
keywords = "Emergency medical services, Epidemiology, Out-of-hospital cardiac arrest, Recurrent cardiac arrest, Secondary prevention, Sudden cardiac death",
author = "Ziad Nehme and Emily Andrew and Resmi Nair and Stephen Bernard and Karen Smith",
year = "2017",
month = "12",
doi = "10.1016/j.resuscitation.2017.08.011",
language = "English",
volume = "121",
pages = "158--165",
journal = "Resuscitation",
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}

Recurrent out-of-hospital cardiac arrest. / Nehme, Ziad; Andrew, Emily; Nair, Resmi; Bernard, Stephen; Smith, Karen.

In: Resuscitation, Vol. 121, 12.2017, p. 158-165.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Recurrent out-of-hospital cardiac arrest

AU - Nehme, Ziad

AU - Andrew, Emily

AU - Nair, Resmi

AU - Bernard, Stephen

AU - Smith, Karen

PY - 2017/12

Y1 - 2017/12

N2 - Background: Little is known about the burden of recurrent out-of-hospital cardiac arrest (OHCA) episodes in initial survivors of OHCA. We sought to investigate the frequency of recurrent OHCA, describe time-to-event trends, and establish baseline predictors of occurrence. Methods: Between January 2000 and June 2015, we included consecutive OHCA survivors to hospital discharge from the Victorian Ambulance Cardiac Arrest Registry. Patient identifiers were used to match index and recurrent episodes of OHCA, and death records from a government database. Kaplan-Meier curves and a Cox proportional-hazards model were used to estimate the long-term risk of recurrent OHCA and identify index characteristics associated with their occurrence. Results: Among 3581 survivors, 214 (6.0%) experienced a recurrent OHCA over a median time-at-risk of 5.0 years (interquartile range [IQR]: 2.0, 8.1). The median age at recurrent OHCA was 69 years, 72.9% were male, and 92.0% of events were fatal. Fatal recurrent OHCA episodes accounted for more than one-quarter of all deaths at follow-up. The probability of recurrent OHCA at 1, 5, 10 and 15 years was 2.4% (95% CI: 2.0%, 3.0%), 6.0% (95% CI: 5.2%, 6.9%), 8.4% (95% CI: 7.3%, 9.8%), and 11.2% (95% CI: 9.1%, 13.8%), respectively. In the multivariable model, the following baseline predictors were significantly associated with recurrent OHCA: respiratory (HR 1.88, 95% CI: 1.02, 3.47; p = 0.045) or overdose/poisoning aetiology (HR 2.47, 95% CI: 1.08, 5.62; p = 0.03), diabetes (HR 1.92, 95% CI: 1.17, 3.14, p = 0.01), heart failure (HR 2.22, 95% CI: 1.28, 3.85; p = 0.005), and renal insufficiency (HR 2.43, 95% CI: 1.23, 4.82; p = 0.01). The risk of recurrent OHCA did not decline over the study period (per year increase: HR 0.97, 95% CI: 0.93, 1.01; p = 0.13). Conclusion: Recurrent OHCA episodes occur frequently in OHCA survivors, and could account for as many as one-quarter of all deaths at follow-up. Index characteristics may help to identify at-risk patients.

AB - Background: Little is known about the burden of recurrent out-of-hospital cardiac arrest (OHCA) episodes in initial survivors of OHCA. We sought to investigate the frequency of recurrent OHCA, describe time-to-event trends, and establish baseline predictors of occurrence. Methods: Between January 2000 and June 2015, we included consecutive OHCA survivors to hospital discharge from the Victorian Ambulance Cardiac Arrest Registry. Patient identifiers were used to match index and recurrent episodes of OHCA, and death records from a government database. Kaplan-Meier curves and a Cox proportional-hazards model were used to estimate the long-term risk of recurrent OHCA and identify index characteristics associated with their occurrence. Results: Among 3581 survivors, 214 (6.0%) experienced a recurrent OHCA over a median time-at-risk of 5.0 years (interquartile range [IQR]: 2.0, 8.1). The median age at recurrent OHCA was 69 years, 72.9% were male, and 92.0% of events were fatal. Fatal recurrent OHCA episodes accounted for more than one-quarter of all deaths at follow-up. The probability of recurrent OHCA at 1, 5, 10 and 15 years was 2.4% (95% CI: 2.0%, 3.0%), 6.0% (95% CI: 5.2%, 6.9%), 8.4% (95% CI: 7.3%, 9.8%), and 11.2% (95% CI: 9.1%, 13.8%), respectively. In the multivariable model, the following baseline predictors were significantly associated with recurrent OHCA: respiratory (HR 1.88, 95% CI: 1.02, 3.47; p = 0.045) or overdose/poisoning aetiology (HR 2.47, 95% CI: 1.08, 5.62; p = 0.03), diabetes (HR 1.92, 95% CI: 1.17, 3.14, p = 0.01), heart failure (HR 2.22, 95% CI: 1.28, 3.85; p = 0.005), and renal insufficiency (HR 2.43, 95% CI: 1.23, 4.82; p = 0.01). The risk of recurrent OHCA did not decline over the study period (per year increase: HR 0.97, 95% CI: 0.93, 1.01; p = 0.13). Conclusion: Recurrent OHCA episodes occur frequently in OHCA survivors, and could account for as many as one-quarter of all deaths at follow-up. Index characteristics may help to identify at-risk patients.

KW - Emergency medical services

KW - Epidemiology

KW - Out-of-hospital cardiac arrest

KW - Recurrent cardiac arrest

KW - Secondary prevention

KW - Sudden cardiac death

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U2 - 10.1016/j.resuscitation.2017.08.011

DO - 10.1016/j.resuscitation.2017.08.011

M3 - Article

VL - 121

SP - 158

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JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -