title: Reduced in-hospital survival rates of out-of-hospital cardiac arrest victims with obstructive pulmonary disease.
abstract: OBJECTIVE
  Out-of-hospital cardiac arrest (OHCA) due to sustained ventricular tachycardia/fibrillation (VT/VF) is common and often lethal. Patient's co-morbidities may determine survival after OHCA, and be instrumental in post-resuscitation care, but are poorly studied. We aimed to study whether patients with obstructive pulmonary disease (OPD) have a lower survival rate after OHCA than non-OPD patients.
  
  
  METHODS
  We performed a community-based cohort study of 1172 patients with non-traumatic OHCA with ECG-documented VT/VF between 2005 and 2008. We compared survival to emergency room (ER), to hospital admission, to hospital discharge, and at 30 days after OHCA, of OPD-patients and non-OPD patients, using logistic regression analysis. We also compared 30-day survival of patients who were admitted to hospital, using multivariate logistic regression analysis.
  
  
  RESULTS
  OPD patients (n=178) and non-OPD patients (n=994) had comparable survival to ER (75% vs. 78%, OR 0.9 [95% CI: 0.6-1.3]) and to hospital admission (56% vs. 57%, OR 1.0 [0.7-1.4]). However, survival to hospital discharge was significantly lower among OPD patients (21% vs. 33%, OR 0.6 [0.4-0.9]). Multivariate regression analysis among patients who were admitted to hospital (OPD: n=100, no OPD: n=561) revealed that OPD was an independent determinant of reduced 30-day survival rate (39% vs. 59%, adjusted OR 0.6 [0.4-1.0, p=0.035]).
  
  
  CONCLUSIONS
  OPD-patients had lower survival rates after OHCA than non-OPD patients. Survival to ER and to hospital admission was not different between both groups. However, among OHCA victims who survived to hospital admission, OPD was an independent determinant of reduced 30-day survival rate.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Blom
authors.forename: M J
authors.initials: MJ
authors.lastname: Warnier
authors.forename: A
authors.initials: A
authors.lastname: Bardai
authors.forename: J
authors.initials: J
authors.lastname: Berdowski
authors.forename: R W
authors.initials: RW
authors.lastname: Koster
authors.forename: P C
authors.initials: PC
authors.lastname: Souverein
authors.forename: A W
authors.initials: AW
authors.lastname: Hoes
authors.forename: F H
authors.initials: FH
authors.lastname: Rutten
authors.forename: A
authors.initials: A
authors.lastname: de Boer
authors.forename: M L
authors.initials: ML
authors.lastname: De Bruin
authors.forename: H L
authors.initials: HL
authors.lastname: Tan
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D010351:Patient Discharge / Q000706:statistics & numerical data*; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality*; D014693:Ventricular Fibrillation / Q000401:mortality*