Hong Kong Journal of Emergency Medicine Outcome and prognostic factors of patients in out-of-hospital cardiac arrests presenting with non-shockable rhythm in Hong Kong KL Leung , CT Lui , KH Cheung , KL T sui , YH T ang Objective:To obtain the recent local epidemiological data and evaluate factors associated with outcomes ofadult patients in non-traumatic non-shockable out-of-hospital-cardiac-arrest (OHCA) in Hong Kong. Methods: It was a cross-sectional study lasting for nine months (from July 2009 to March 2010) in two emergency departments (ED) which served a population of 1.1 million. All non-traumatic OHCA patients aged equal or greater than 18 years presented with non-shockable cardiac rhythms to ED without post- mortem changes were included. The pre-hospital factors, managements and outcomes were recorded in a standardised data entry form at the time of patient consultation. Logistic regression was used to evaluate the relationship between survival to admission (STA) and various prognostic factors. Results: A total of 348 patients fulfilled the inclusion criteria. The mean age was 75.9 years old. Overall, there were 61 patients (17.5 %) with restoration of spontaneous circulation and 58 patients (16.7%) had STA. The survival to hospital discharge (STD) rate was 0.86% (3 patients). Factors independently associated with better prognosis in terms of STA were initial pulseless electrical activity arrest (PEA) rhythm in ED (OR=4.72, 95% CI 2.30- 9.69), witnessed arrest (OR=8.00, 95% CI 3.38-18.96) and non-cardiac cause of arrest (OR=2.17, 95% CI 1.00-4.67). Conclusion:STA for adults presenting with non-traumatic non-shockable OHCA in our centre is 16.7%. Witnessed non-shockable OHCA patients presenting with initial PEA arrest rhythm and with a presumed non-cardiac in etiology are significantly associated with higher STA rate. (Hong Kong j.emerg. med. 2012;19:xx-xx) OHCAED( 110 ) 9 2009 7 2010 3 18 OHCASTA3 4 8 75.9 6 1 17.5 58 1 6 .7 S T A S T D 0.8 6 3 S T A : ED PEA OR= 4 .72 95 CI 2 .30-9. 6 9 OR=8. 0 0 95 CI 3.38 - 18.9 6 OR=2.17 95 CI1.00 - 4 . 67 Correspondence to: Cheung Koon Ho, MRCSEd, FHKCEM, FHKAM(Emergency Medicine) Prince of Wales Hospital , Accident and Emergency Department, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong (previously at Tuen Mun Hospital, Accident and EmergencyDepartment) Email: [email protected]T uen Mun Hos pital , Accident and Emergency Department, Tsing Chung Koon Road, Tuen Mun, New T erritories, Hong Kong Leung Kwong Leung, MBChB Lui Chun Tat, MBBS(HK), FHKCEM, FHKAM(Emeregncy Medicine) Tsui Kwok Leung, FRCSEd, FHKCEM, FHKAM(Emergency Medicine) Tang Yiu Hang, FRCSEd, FHKCEM, FHKAM(Emergency Medicine)
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Non-Shockable Out-Of-hospital Cardiac Arrest in HK
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8/3/2019 Non-Shockable Out-Of-hospital Cardiac Arrest in HK
Outcome and prognostic factors of patients in out-of-hospital cardiac
arrests presenting with non-shockable rhythm in Hong Kong
KL Leung , CT Lui , KH Cheung , KL Tsui , YH Tang
Objective: To obtain the recent local epidemiological data and evaluate factors associated with outcomes of adult patients in non-traumatic non-shockable out-of-hospital-cardiac-arrest (OHCA) in Hong Kong.
Methods: It was a cross-sectional study lasting for nine months (from July 2009 to March 2010) in two
emergency departments (ED) which served a population of 1.1 million. All non-traumatic OHCA patients
aged equal or greater than 18 years presented with non-shockable cardiac rhythms to ED without post-mortem changes were included. The pre-hospital factors, managements and outcomes were recorded in astandardised data entry form at the time of patient consultation. Logistic regression was used to evaluate the
relationship between survival to admission (STA) and various prognostic factors. Results: A total of 348patients fulfilled the inclusion criteria. The mean age was 75.9 years old. Overall, there were 61 patients
(17.5 %) with restoration of spontaneous circulation and 58 patients (16.7%) had STA. The survival tohospital discharge (STD) rate was 0.86% (3 patients). Factors independently associated with better prognosis
in terms of STA were initial pulseless electrical activity arrest (PEA) rhythm in ED (OR=4.72, 95% CI 2.30-9.69), witnessed arrest (OR=8.00, 95% CI 3.38-18.96) and non-cardiac cause of arrest (OR=2.17, 95% CI
1.00-4.67). Conclusion: STA for adults presenting with non-traumatic non-shockable OHCA in our centreis 16.7%. Witnessed non-shockable OHCA patients presenting with initial PEA arrest rhythm and with a
presumed non-cardiac in etiology are significantly associated with higher STA rate. (Hong Kong j.emerg.med. 2012;19:xx-xx)
OHCA
ED ( 110 )
9 2009 7 2010 3 18
OHCA
STA
348 75.9 61 17.5
58 16.7 STA STD 0.86 3 STA
: ED PEA OR= 4.72 95 CI2.30-9.69
OR=8.00 95 CI 3.38-18.96 OR=2.17 95 CI1.00-4.67
Correspondence to:Cheung Koon Ho, MRCSEd, FHKCEM, FHKAM(Emergency Medicine)
Prince of Wales Hospital, Accident and Emergency Department,30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong(previously at Tuen Mun Hospital, Accident and Emergency Department) Email: [email protected]
Tuen Mun Hospital, Accident and Emergency Department, TsingChung Koon Road, Tuen Mun, New Territories, Hong KongLeung Kwong Leung, MBChB
Lui Chun Tat, MBBS(HK), FHKCEM, FHKAM(Emeregncy Medicine)
statistically significant factors associated with better
outcome in non-shockable OHCA. However, these
factors were not directly affected by a simple changein practice or improvement in the standard of
resuscitation delivered within hospital setting.
However, these information could be useful to guide
our approach, utilisation of resources and duration of
resuscitation on further non-shockable OHCA cases.
Although our study showed improvement in ROSC
and STA, STD remained to be low (0.86%). One
reason could be unsatisfactory post-resuscitation
supports. In our study, there were 61 subjects (17.5%)
with ROSC after resuscitation and 58 patients (16.7%)
with STA, however only 14 patients (24.1%) were
admitted to intensive care unit (ICU) or coronary care
unit (CCU) and most of them were admitted to general
ward. If more STA patients could receive intensive care
support, survival outcomes might be better.
Despite the poor survival outcome of our study with non-
shockable OHCA, our reported ROSC and STA were
slightly better than the rates reported in the previous local
studies in Hong Kong. During 1998-2004, the overallROSC rate of non-traumatic OHCA was 7.6% as shown
in a study by Chung & Wong.16 During 2001-2003, STA
rate for asystole and PEA were 9.8% and 9.1% respectively
reported by Lau et al10 Based on 2002 data, a teaching
hospital in Hong Kong reported ROSC rate as 26.8%,
STA rate as 12.1% for witnessed cardiogenic OHCA
patients presented with asystole and PEA.18 In our study,
the rate for ROSC and STA rate in non-shockable cardiac
arrests were 17.5% and 16.7% respectively, while STD
rate was 0.86%. The overall survival rate (in terms of
ROSC and STA) was higher when compared with localrates before 2005. In 2005, there was the implementation
of new guideline. Our study reflected resuscitation
outcome with AHA 2005 Guidelines. Further studies
would be required to monitor the impact on the outcomes
of OHCA after the implementation of the new AHA
2010 resuscitation guidelines.
Limitations A difficulty in our CAR was unsatisfactory on-site
completion rate of CAR forms. We had an audit on
this issue and found that around 29% cases had at
least one missing data or incorrect input. Such missing
information were filled retrospectively with reference
to available documentations in A&E notes and
ambulance records. Inadequate information inambulance records regarding pre-hospital data were
found in many cases.
Another limitation of our study was absence of pre-
hospital time interval. The reason was that while we
could not get pre-hospital time data in Ambulance
Journey Report, there was considerable problem of
missing data and recall bias when pre-hospital time
was obtained from bystanders. Furthermore, presumed
causes of cardiac arrest were clinical judgment by the
attending physicians instead of autopsy results. This
could be a problem because clinical judgement could
be inaccurate and leading to incorrect classification.19
Finally, number of STD cases was too small to allow a
proper analysis like the neurologically outcome of the
survivors.
Conclusion
STA and STD for adults in non-traumatic non-shockable OHCA in our centre based on AHA 2005
Guidelines are 16.7% and 0.86% respectively. For non-
shockable, non-traumatic OHCA aged 18 years or
above, three independent prognostic factors are
significantly associated with higher chance of STA:
witnessed arrest, initial PEA arrest rhythm in ED, and
causes not due to cardiac origin. In Hong Kong, use
of CAR can monitor OHCA characteristics and
identify rooms for improvement in our practice. We
suggest continual maintenance and development of an
uniform, territory-wide CAR in our locality.
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