Clinical profile and outcomes of resuscitated cardiac arrest patients: a 10-year analysis of IHCA and OHCA comatose patients at a cardiac intensive care unit
M Urpina Matias, M I Soares, R Montalvao, M Presume, J Machado, A R Bello, M Sousa Paiva, J Presume, J Ferreira, C BrizidoAbstract
Background
Sudden cardiac arrest (CA) remains a major public health concern with high morbimortality and economic burden. Despite improvements in pre- and in-hospital resuscitation protocols and expanding ECPR use, survival and neurological recovery remains limited.
Purpose
To describe clinical and event-related characteristics, and identify factors associated with poor neurologic and functional outcomes in comatose CA patients admitted to a cardiac intensive care unit (CICU).
Methods
Retrospective analysis of consecutive comatose patients (GCS<8) admitted to a CICU after resuscitation from in-hospital or out-of-hospital CA (IHCA or OHCA), between 2015-2025. Patients underwent multimodal neuroprognostication and were stratified according to probability of poor neurological outcome according to 2025 European Resuscitation Council (ERC) Guidelines. The primary outcome was neurological status at 30 days, using the Cerebral Performance Category (CPC) scale, categorizing patients as good (1–2) vs poor (3–5). Bivariate analyses were performed using Chi-Square and Mann-Whitney.
Results
94 patients (mean age 62 ± 17 y, 70% male) were included; 32% had IHCA. Most OHCA were witnessed (90%) and 72% received bystander CPR. Mean no-flow time was 1.8, median low-flow time was 15 [8.5-18.8], and time to ROSC 25 [16-40] minutes. Post-ROSC care included TTM targeting normothermia in 62%, though 35% developed fever within 72 hours. According to ERC criteria, one third of 90 patients completing neuroprognostication were classified with poor neurological prognosis. At 30 days, 71% had CPC 3-5 and 62% died, mainly from early hemodynamic instability and multiorgan failure, and later from withdrawal of life-sustaining therapies. Baseline features and comorbidities were similar across prognosis groups. Poor neuroprognosis and CPC 3-5 were more frequent in OHCA (96% vs 55%; p= 0.0001; and 76% vs 48%; p=0.008, respectively). Longer low-flow time correlated with poor ERC prognosis (p=0.04) and CPC 3-5 (p=0.01), while no-flow and time-to-ROSC did not differ. Initial rhythm (shockable rhythm occurred in 65%, pulseless electrical activity in 26%), and ECPR use (10%, n=9) showed no association with outcomes. STEMI on post-ROSC ECG was significantly linked to poor neuroprognosis (p=0.02). After admission, coronary revascularization and LVEF were not related to CPC or ERC neuroprognosis. Fever during the first 72h occurred more frequently in patients with poor neuroprognosis, despite not meeting statistical significance (50% vs 29%, p= 0.08).
Conclusion
Despite rapid and mostly witnessed resuscitation, OHCA and longer low-flow time were consistently higher in patients with poor neuroprognosis and functional outcomes at 30 days. This study suggests pre-hospital conditions and primary cardiovascular prevention are still the main targets to improve post-CA outcomes.