• T Cassina, S Clivio, A Putzu, M Villa, T Moccetti, D Fortuna, and G Casso.
• Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: tiziano.cassina@cardiocentro.org.
• Med Intensiva. 2020 Oct 1; 44 (7): 409-419.

ObjectiveA study was made of the events occurring in the early post-resuscitation phase that may help to improve the outcomes at hospital discharge.DesignA retrospective cohort study (2007-2017) of a prospective Utstein type registry database was carried using multivariate logistic regression analysis. Pre- and post-hospital admission events were investigated.SettingA tertiary cardiac centre.ParticipantsUnconscious victims of out-of-hospital cardiac arrest (OHCA) with documented ventricular tachycardia or fibrillation.Main Variables Of InterestEvents occurring before and within 72h after intensive care unit (ICU) admission were recorded. The variables were analyzed to determine their impact on hospital survival and poor neurological outcome. One-year follow-up survival was also considered. Results are presented as odds ratio (OR) and 95% confidence interval (95%CI).ResultsOf 245 patients admitted to our ICU after OHCA, 152 (62%) were alive and 131 (86.2%) presented good neurological outcomes (cerebral performance categories≤2) at hospital discharge. The one-year follow-up survival rate was 95.9%. Age >70 years (OR 2.0; 95%CI 1.1-4.1), previous myocardial infarction (OR 2.7; 95%CI 1.2-6.1), shock upon hospital admission (OR 2.9; 95%CI 1.3-6.2), time from call to return of spontaneous circulation (ROSC) >25min (OR 3.1; 95%CI 1.6-6.0) and anticonvulsant therapy (OR 18.2; 95%CI 5.5-60) were independent predictors of poor neurological outcome. Immediate admission to the cardiac centre (OR 0.5; 95%CI 0.3-0.9) and lactate clearance reaching plasma levels <2.5mmol/l at 12h (OR 0.4; 95%CI 0.2-0.8) were associated with better outcomes.ConclusionsUnconscious OHCA patients with documented ventricular tachycardia or fibrillation may benefit from direct admission to a reference cardiac centre. Initial haemodynamic support, urgent coronary angiography and targeted management in the cardiac ICU seem to increase the likelihood of good neurological outcomes.Copyright © 2019 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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