Temporal trends in clinical outcomes among patients with out-of-hospital cardiac arrest of cerebrovascular origin
K Tateishi, Y Saito, K Kato, H Kitahara, Y Kobayashi, N Yonemoto, T Matoba, Y TaharaAbstract
Backgrounds
Advances in diagnostic and therapeutic strategies have significantly improved outcomes in patients with cerebrovascular accidents (CVA). However, the prognosis after out-of-hospital cardiac arrest (OHCA) of cerebrovascular origin remains poor, and data on the trends and outcomes are limited. In addition, although adrenaline use has increased and been associated with higher prehospital return of spontaneous circulation (ROSC) rates, its impact on outcomes in CVA-related OHCA remains unclear.
Purpose
To assess clinical characteristics, temporal trends, and outcomes of OHCA due to CVA, including trends in adrenaline use and its association with ROSC.
Methods
Using a nationwide registry database from 2006 to 2023, a cohort of 2,107,578 adults with OHCA was analyzed. Patients were divided into two groups according to the presence or absence of CVA as an etiology of OHCA. Clinical outcomes, including prehospital ROSC and overall and neurologically favorable (Cerebral Performance Category score of 1 or 2) survival at 1 month, were evaluated. Temporal trends in these outcomes were compared between the CVA and non-CVA groups. A potentially influential effect of prehospital use of adrenaline was also assessed.
Results
Of the 2,107,578 patients, 67,916 (3.2%) had CVA as an etiology of OHCA. As compared with the non-CVA group, patients in the CVA group were significantly younger and had a lower prevalence of an initial shockable rhythm. Although the probability of prehospital ROSC was higher (15.3% vs 7.6%, P<0.001), both 1-month overall survival (4.0% vs 4.5%, P<0.001) and neurologically favorable survival rates (1.3% vs 2.1%, P<0.001) were significantly lower in the CVA group than in the non-CVA group. From 2006 to 2023, the rate of prehospital ROSC increased in both the CVA and non-CVA groups, with a more pronounced increase in the CVA group. (Fig 1) In contrast, overall survival and neurologically favorable survival rates remained largely unchanged in both groups throughout the study period. (Fig 1) During the study period, the overall use of adrenaline progressively increased. (Fig 2A) In analyses stratified by adrenaline use, patients in the CVA group treated with adrenaline had an approximately twofold higher ROSC rate than adrenaline-treated patients in the non-CVA group. (Fig 2B) However, no significant temporal change in ROSC was observed within the adrenaline-treated patients in the CVA group. (P for trend 0.434)
Conclusions
In the present nationwide registry study, CVA accounted for 3.2% of etiologies of OHCA. Among patients with OHCA due to CVA, the rates of prehospital ROSC were high and increased during the study period, while this did not translate into improved survival. The temporal increase in ROSC observed in the CVA group may be attributable to the increasing use of adrenaline over time, with a greater resuscitative effect of adrenaline in patients with CVA as an etiology of OHCA than those without.