title: [Prognosis of patients admitted in a coronary care unit after resucitating from out-of-hospital sudden cardiac death].
abstract: OBJECTIVE
  The aims of the present study were to analyze the prognosis after resuscitation from out-of-hospital sudden cardiac death in patients admitted to the coronary care unit, and to identify the predictor variables of morbi-mortality.
  
  
  METHODS
  From November 1999 to January 2004 we analyzed 63 patients (47 males) aged 61 +/- 12 years who were admitted to the coronary care unit following successful resuscitation from sudden cardiac death. The clinical and electrocardiographic characteristics were correlated with the mortality and neurological impairment.
  
  
  RESULTS
  Thirty-five patients (55.5%) were discharged, while twenty-eight patients (45.5%) died 28 +/- 4 days after admission, most of them during hospitalization. The main underlying disorder was coronary artery disease (80.9%). When survivors and non-survivors were compared, the variables associated with a worse prognosis were diabetes mellitus (68.4% vs 17.1%, P < .02), the presence of valvular heart disease (28.6% vs 0%, p < 0.003), chronic atrial fibrillation (42.9% vs 14.3%, P < .02) and asystole as the initial rhythm observed (42.9% vs 11.4%, P < .01). Multivariate analysis identified asystole as an independent factor of poor prognosis (P < .02). Death was due to severe postanoxic neurological damage in 23 of 28 deaths (82.1%). The remaining 5 patients died due to their underlying cardiac disease (P < .01). The variables associated with neurological damage were out-of hospital resuscitation, delay in beginning resuscitation maneuvers, arrival time > 5 minutes and unconsciousness on admission.
  
  
  CONCLUSIONS
  Although many patients survive following resuscitation from out-of-hospital sudden cardiac death, mortality remains high. Neurological impairment is the main cause of mortality. Prognosis is determined by the variables related to the underlying disease, the delay in onset of resuscitation maneuvers and postanoxia cerebral damage.
authors.affiliation: Unidad de Cuidados Intensivos Coronarios. Servicio de Cardiología. Hospital de la Santa Creu i Sant Pau. Barcelona. España. ermenvg@hotmail.com
authors.forename: Ermengol
authors.initials: E
authors.lastname: Vallès
authors.forename: Vicens
authors.initials: V
authors.lastname: Martí
authors.forename: Mariana
authors.initials: M
authors.lastname: Noguero
authors.forename: Josep
authors.initials: J
authors.lastname: Guindo
authors.forename: José M
authors.initials: JM
authors.lastname: Domínguez de Rozas
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D003325:Coronary Care Units; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D016019:Survival Analysis; D017741:Survivors; D014187:Transportation of Patients