Published online before print September 28, 2009, doi: 10.1161/CIRCHEARTFAILURE.108.828095
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Original Articles |
Factors Associated With Neurologically Intact Survival for Patients With Acute Heart Failure and In-Hospital Cardiac Arrest
From the Department of Emergency Medicine and the Cardiovascular Research Institute (P.D.L., R.W.), Wayne State University School of Medicine, Detroit, Mich; Department of Radiation Oncology (H.Y.), William Beaumont Hospital, Royal Oak, Mich; Department of Emergency Medicine (S.C.), University of Medicine and Dentistry, Newark, NJ; Mid America Heart Institute (P.S.C.), St. Luke' Health System, Kansas City, Mo; Department of Emergency Medicine (G.L.L.), Yale School of Medicine, New Haven, Conn.
Correspondence to Phillip D. Levy, MD, MPH, Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, Detroit, MI 48201. E-mail plevy{at}med.wayne.edu
Received January 7, 2009; accepted September 23, 2009.
Background— Hospitalized patients with heart failure are at risk for cardiac arrest. The ability to predict who may survive such an event with or without neurological deficit would enhance the information on which patients and providers establish resuscitative preferences.
Methods and Results— We identified 13 063 adult patients with acute heart failure who had cardiac arrest at 457 hospitals participating in the National Registry of Cardiopulmonary Resuscitation between January 1, 2000 and December 31, 2007. Neurological status was determined on admission and discharge by cerebral performance category with neurologically intact survival (NIS)=cerebral performance category 1 (no) or 2 (moderate dysfunction) and non-NIS=cerebral performance category 3 (severe dysfunction), 4 (coma), or 5 (brain death). Factors available prearrest (demographics, preexisting conditions, and interventions in-place) were assessed for association with NIS using multivariable logistic regression, initially without then with adjustment for arrest-related variables and hospital characteristics. NIS occurred in 2307 patients (17.7%) and was associated by adjusted odds ratio with 18 prearrest factors; 4 positively and 14 negatively. The association (odds ratio; 95% CI) was strongest for 4 specific variables: acute stroke (0.38; 0.25 to 0.58), history of malignancy (0.49; 0.39 to 0.63), vasopressor use (0.50; 0.43 to 0.59), and assisted or mechanical ventilation (0.53; 0.45 to 0.61).
Conclusions— A number of prearrest factors seem to be associated with NIS, the majority inversely. Consideration of these before cardiac arrest could enhance the resuscitative decision-making process for patients with acute heart failure.
Key Words: acute heart failure • cardiac arrest • cerebral performance category • neurologically intact survival