Background

Rearrest occurs commonly after initial resuscitation following out-of-hospital cardiac arrest (OHCA). We determined (1) the predictors of rearrest during hospitalisation that can be identified in the hours immediately after OHCA, (2) the association between rearrest and favourable long-term outcomes, and (3) the predictors of favourable long-term outcomes in rearrest patients.

Methods

Conditional multivariable logistic regression analyses were performed using the Korean Hypothermia Network prospective registry data, which included details of adult OHCA patients treated with targeted temperature management at 22 teaching hospitals in South Korea.

Results

Among the 1,233 patients, 260 (21.1%) experienced rearrest. Of the 192 patients resuscitated from first rearrest, 33 (17.2%) achieved 6-month favourable outcomes. Arrhythmia, heart failure, ST-segment elevation, lower initial Glasgow coma scale (GCS) motor score, higher initial lactate level, and antiarrhythmic drug use within 1 h were independently associated with rearrest. Higher lactate level and antiarrhythmic drug use were associated with shockable first rearrest, while arrhythmia, heart failure, ST-segment elevation, and lower GCS motor score were associated with non-shockable first rearrest. Rearrest was independently associated with a lower likelihood of 6-month favourable outcomes (P = 0.003). Initial shockable rhythm after OHCA, absence of diabetes, shorter cumulative time to restoration of spontaneous circulation, coronary angiography, and hypophosphataemia within 7 d were independently associated with 6-month favourable outcomes in the patients resuscitated from first rearrest.

Conclusions

Rearrest during hospitalisation after OHCA was inversely associated with 6-month favourable outcomes. We identified several risk factors for rearrest and prognostic factors for patients resuscitated from first rearrest.

中文翻译：

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成人昏迷的院外心脏骤停患者住院期间再次发作：危险因素和预后影响，以及长期预后良好的预测因素

背景

院外心脏骤停 (OHCA) 后的初次复苏后通常发生再次发作。我们确定了（1）可以在 OHCA 后立即确定的住院期间再次逮捕的预测因素，（2）再次逮捕与有利的长期结果之间的关联，以及（3）再次逮捕中有利的长期结果的预测因素耐心。

方法

使用韩国低温网络前瞻性注册数据进行条件多变量逻辑回归分析，其中包括在韩国 22 家教学医院接受目标温度管理的成年 OHCA 患者的详细信息。

结果

在 1,233 名患者中，260 人（21.1%）经历了再次逮捕。192 名从第一次再次停止复苏的患者中，33 名 (17.2%) 获得了 6 个月的良好结果。心律失常、心力衰竭、ST 段抬高、较低的初始格拉斯哥昏迷评分 (GCS) 运动评分、较高的初始乳酸水平和 1 小时内使用抗心律失常药物与再次停止独立相关。较高的乳酸水平和抗心律失常药物的使用与可电击的第一次再呼吸有关，而心律失常、心力衰竭、ST 段抬高和较低的 GCS 运动评分与不可电击的第一次再呼吸有关。再次逮捕与 6 个月有利结果的可能性较低独立相关（P = 0.003）。OHCA 后的初始可电击节律，无糖尿病，恢复自主循环的累积时间较短，冠状动脉造影，

结论

OHCA 后住院期间的再次发作与 6 个月的良好结果呈负相关。我们确定了从第一次再逮捕中复苏的患者的再逮捕的几个危险因素和预后因素。