• Cecilia Andréll, Josef Dankiewicz, Christian Hassager, Janneke Horn, Jesper Kjærgaard, Matilde Winther-Jensen, Matt P Wise, Niklas Nielsen, Pascal Stammet, Hans Friberg, and TTM Trial Investigators.
• Center for Cardiac Arrest, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden - cecilia.andrell@med.lu.se.
• Minerva Anestesiol. 2019 Jul 1; 85 (7): 738-745.

BackgroundThe majority of out-of-hospital cardiac arrests (OHCAs) occur at place of residence, which is associated with worse outcomes in unselected prehospital populations. Our aim was to investigate whether location of arrest was associated with outcome in a selected group of initial survivors admitted to intensive care.MethodsThis is a post-hoc analysis of the Targeted Temperature Management After Cardiac Arrest (TTM) trial, a multicenter controlled trial, randomizing 950 OHCA patients to an intervention of 33 °C or 36 °C. The location of cardiac arrest was defined as place of residence versus public place or other. The outcome measures were mortality and neurological outcome, as defined by the Cerebral Performance Category Scale, at 180 days.ResultsApproximately half of 938 included patients arrested at place of residence (53%). Location groups did not differ with respect to age (P=0.11) or witnessed arrests (P=0.48) but bystander CPR was less common (P=0.02) at place of residence. OHCA at place of residence was associated with higher 180-day mortality (55% vs. 38%, P<0.001) and worse neurological outcome (61% vs. 43%, P<0.001) compared with a public place or other. After adjusting for known confounders, OHCA at place of residence remained an independent predictor of mortality (P=0.007).ConclusionsHalf of all initial survivors after OHCA admitted to intensive care had an arrest at place of residence which was independently associated with poor outcomes. Actions to improve outcomes after OHCA at place of residence should be addressed in future trials.

36 keywords...

hide…