IN-HOSPITAL MORTALITY AFTER OUT-OF-HOSPITAL CARDIAC-ARREST

In-hospital management of out-of-hospital cardiac arrest is complicate d by uncertainty about prognosis and the need to identify markers of a dverse outcome in individuals surviving initial resuscitation. We soug ht to identify factors that predict in-hospital death among patients w ho initially survive out-of-hospital cardiac arrest. We investigated 3 46 consecutive cases of out-of-hospital cardiac arrest received by a s ingle centre in Edinburgh, UK (270 cases examined retrospectively, 76 prospectively). Of the retrospective cohort, 246 cases were thought to be of cardiac origin. There were associations between in-hospital mor tality and pre-arrest variables, resuscitation variables, and factors measured during admission. Crew-witnessed arrests were associated with low mortality; arrest rhythm (p<0.001), resuscitation by a health pro fessional (p<0.05), conscious level on admission (p<0.001), and requir ement for ventilaton (p<0.05) independently predicted in-hospital mort ality. A weighted prognostic scoring system based on three of these va riables accurately predicted the likelihood of in-hospital death in th e prospective test group. Further assessment of conscious level during admission with the Glasgow coma score predicted mortality rates in th e study population, but coma did not predict a hopeless prognosis in i ndividual cases unless it persisted for 72 h or more. Accurate prognos tic assessment of out-of-hospital cardiac arrest survivors can be made from information available on admission. Of factors that independentl y predicted outcome, the skill of the resuscitator is most readily mod ified. This suggests that public training in resuscitation may reduce mortality rates.