Prevelence and Factors Associated with Neurological Outcomes of Adult in Hospital Cardiac Arrests in a Tertiary Care Hospital-A Retrospective Observational Study

Abstract

Introduction

Great advances in cardiopulmonary resuscitation(CPR) are made in recent years, majority of successful resuscitations still present comatose, with altered consciousness due to irreversible hypoxic-ischemic encephalopathy. Brain is injured directly as a result of loss of and suboptimal blood flow during the arrest that depends on quality of CPR and associated factors. The accuracy, timing of neuroprognostication are of utmost importance for avoiding premature withdrawal of life-sustaining treatment (WLST), futile treatment prolongation and hence burden on public health resources. ²

Objectives

This study aimed to investigate factors affecting neurological outcomes for neuroprognostication after in hospital cardiac arrest.

Materials and methods

After ethical committee clearance, we retrospectively reviewed data of patients ≥ 18 years who experienced in-hospital cardiac arrest between July 2022- June2023 at our hospital. CPC(cerebral performance category) score was assessed for cardiac arrest survivors at discharge. CPC score of 1,2 classified as good neurological status and scores 3,4,5 classified as poor neurological status. Data was collected from CPR form in accordance with AHA and ERC which is recorded soon after arrest.

Results

In total,256 patients were included. Rate of survival to discharge was 17%(n = 44), Neurological condition was assessed in 44 patients, favourable neurological outcome observed in 50%(22/44) at discharge. Neuroprognosis(CPC1,2) was better with cardiac origin of arrest(70%, P<0.01), initial rhythm (VT, VF)(75%, p<0.01), median duration of CPR was 4min and 32 (p,0.01) min in patients with cpc 1,2 and cpc 3,4,5 respectively. Arrest time was within 1minute not significantly different in both groups(P = 0.95).

Conclusion

Among survivors, factors favoring good neurological outcomes were lesser CPR duration, shockable initial rhythm and cardiac origin of arrest.