DOI: 10.1097/CCM.0000000000000735
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PMID: 25514741
Issn Print: 0090-3493
Publication Date: 2015/01/01
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Excerpt
In our analyses, we did not include preexisting comorbidities other than hypertension and diabetes for several reasons. In the setting of OHCA, patients’ previous medical data are often not sound or even lacking and difficult to verify. This category of information is commonly lacking in OHCA databases, as these variables are not part of the Utstein template core (3). Nonetheless, a medical evaluation of patients was systematically provided on the field by the emergency team. As a result, bedridden patients or patients with do-not-resuscitate orders were not referred to ICU. Furthermore, we did not include patients who presented a cardiac arrest in long-term facilities, as they were considered intrahospital cardiac arrest (IHCA). Thus, the patients with the most severe comorbidities that could have truly impacted on the short-term prognosis were not included in the study. Finally, all patients were free of severe chronic brain disease before OHCA.
We are not aware of data sustaining the statement of Xue et al (1) that comorbidities influence the time from collapse to cardiopulmonary resuscitation (CPR) and the cumulate dose of adrenaline during CPR. Besides OHCA characteristics, our policy is to treat OHCA patients with maximal postresuscitation care until neurological evaluation. Thus, although we cannot exclude that some comorbidities other than hypertension and diabetes would be statistically associated with ICU survival, we believe that the variables included in our multivariate model are important and independent determinants of short-term prognosis.
We agree with Xue et al (1) that comorbidities obviously influence the long-term prognosis of OHCA survivors, and we believe that this also applies to younger patients. Their absence is a limitation of most studies looking at long-term survival of OHCA patients. Xue et al (1) refer to a study of survivors from IHCA (4), which showed that comorbidities were associated with the 1-year survival. As IHCA occurs in patients with a disease severe enough to require hospitalization before cardiac arrest, the statistical weight of comorbidities is higher than in OHCA and the variables determining the prognosis are different (5). As patients suffering IHCA do not reflect the population having OHCA, the generalization of evidence from IHCA databases should be made with caution.
Finally, we aimed to determine the excess of mortality in OHCA survivors in comparison with subjects from the community of comparable age. We observed that OHCA survivors have a standardized mortality four times higher as compared with community people who are younger than 75 years and nearly two times higher when restricting the comparison to the people with previous cardiovascular disease. This finding suggests that OHCA survivors should be considered as high-risk patients, as highlighted by the major cardiovascular event rate of 23% during the follow-up (3). We agree with Xue et al (1) that this level of risk is similar in patients with cardiac insufficiency (5) or with comorbidities matched to survivors with cardiac arrest (6), but the comparisons with such populations were not our goal.
