title: Predictors of inhospital mortality following out-of-hospital cardiac arrest: Insights from a single-centre consecutive case series.
abstract: OBJECTIVE
  Out-of-hospital cardiac arrest (OHCA) has a poor prognosis despite bystander resuscitation and rapid transfer to hospital. Optimal management of patients after arrival to hospital continues to be contentious, especially the timing of emergency coronary angiography±revascularisation. Robust predictors of inhospital outcome would be of clinical value for initial decision-making.
  
  
  METHODS
  A retrospective analysis of consecutive patients who presented to a university hospital following OHCA over a 70-month period (2008-2013). Patients were identified from the emergency department electronic patient registration and coding system. For those patients who underwent emergency percutaneous coronary intervention, details were crosschecked with national databases.
  
  
  RESULTS
  We identified 350 consecutive patients who were brought to our hospital following OHCA. Return of spontaneous circulation (ROSC) for >20 min was achieved either before arrival or inhospital in 196 individuals. From the 350 subjects, 114 (32.6%) survived to hospital discharge. When sustained ROSC was achieved, either before or inhospital, survival to discharge was 58.2% (114 of 196). Non-shockable rhythm, absence of bystander cardiopulmonary resuscitation, 'downtime' >15 min and initial pH ≤7.11 were predictors of inhospital death. 12% patients who underwent angiography in the presence of ST elevation had no acute coronary occlusion. 21% patients with acute coronary occlusion at angiography did not have ST elevation.
  
  
  CONCLUSIONS
  In our cohort of patients with OHCA, those who achieve ROSC had a survival-to-discharge rate of 58.2%. We identified four predictors of inhospital death, which are readily available at the time of patient presentation. Reliance on ST elevation to decide about coronary angiography and revascularisation may be flawed. More data are required.
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Whittaker
authors.affiliation: Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Manpreet
authors.initials: M
authors.lastname: Lehal
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Calver
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Corbett
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Deakin
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Huon
authors.initials: H
authors.lastname: Gray
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Simpson
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: James R
authors.initials: JR
authors.lastname: Wilkinson
authors.affiliation: Department of Cardiology, Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Curzen
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D061665:Time-to-Treatment; D006113:United Kingdom / Q000453:epidemiology
keywords: ACCIDENT & EMERGENCY MEDICINE