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AuthorKurtz, Pedro
AuthorStorm, Christian
AuthorSoares, Marcio
AuthorBozza, Fernando A.
AuthorMaciel, Carolina B.
AuthorGreer, David M.
AuthorBastos, Leonardo S. L.
AuthorMelo, Ulisses
AuthorMazza, Bruno
AuthorSantino, Marcelo S.
AuthorLannes, Roberto Seabra
AuthorMoraes, Ana Paula Pierre de
AuthorPassos, Joel Tavares
AuthorMoralez, Giulliana Martines
AuthorSantos, Robson Correa
AuthorMachado, Maristela Medeiros
AuthorSaturnino, Saulo Fernandes
AuthorMendes, Ciro Leite
AuthorVianna, Arthur Oswaldo
AuthorSalluh, Jorge
Access date2021-12-28T14:18:01Z
Available date2021-12-28T14:18:01Z
Document date2021
CitationKURTZ, Pedro et al. Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study. Critical care explorations, v. 3, n. 7, p. 1-11, 2021pt_BR
ISSN2639-8028pt_BR
URIhttps://www.arca.fiocruz.br/handle/icict/50540
Languageengpt_BR
PublisherWolters Kluwer Healthpt_BR
Rightsopen accesspt_BR
TitleClinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Studypt_BR
TypeArticlept_BR
DOI10.1097/CCE.0000000000000479
AbstractObjectives: Data on cardiac arrest survivors from developing countries are scarce. This study investigated clinical characteristics associated with in-hospital mortality in resuscitated patients following cardiac arrest in Brazil. Design: Retrospective analysis of prospectively collected data. Setting: Ninety-two general ICUs from 55 hospitals in Brazil between 2014 and 2015. Patients: Adult patients with cardiac arrest admitted to the ICU. Interventions: None. Measurements and main results: We analyzed 2,296 patients (53% men; median 67 yr (interquartile range, 54-79 yr]). Eight-hundred patients (35%) had a primary admission diagnosis of cardiac arrest suggesting an out-of-hospital cardiac arrest; the remainder occurred after admission, comprising an in-hospital cardiac arrest cohort. Overall, in-hospital mortality was 83%, with only 6% undergoing withholding/withdrawal-of-life support. Random-effects multivariable Cox regression was used to assess associations with survival. After adjusting for age, sex, and severity scores, mortality was associated with shock (adjusted odds ratio, 1.25 [95% CI, 1.11-1.39]; p < 0.001), temperature dysregulation (adjusted odds ratio for normothermia, 0.85 [95% CI, 0.76-0.95]; p = 0.007), increased lactate levels above 4 mmol/L (adjusted odds ratio, 1.33 [95% CI, 1.1-1.6; p = 0.009), and surgical or cardiac cases (adjusted odds ratio, 0.72 [95% CI, 0.6-0.86]; p = 0.002). In addition, survival was better in patients with probable out-of-hospital cardiac arrest, unless ICU admission was delayed (adjusted odds ratio for interaction, 1.63 [95% CI, 1.21-2.21]; p = 004). Conclusions: In a large multicenter cardiac arrest cohort from Brazil, we found a high mortality rate and infrequent withholding/withdrawal of life support. We also identified patient profiles associated with worse survival, such as those with shock/hypoperfusion and arrest secondary to nonsurgical admission diagnoses. Our findings unveil opportunities to improve postarrest care in developing countries, such as prompt ICU admission, expansion of the use of targeted temperature management, and implementation of shock reversal strategies (i.e., early coronary angiography), according to modern guidelines recommendations.pt_BR
AffilliationInstituto Estadual do Cérebro Paulo Niemeyer. Departamento de Neurointensiva. Rio de Janeiro, RJ, Brasil / Hospital Copa Star. Departamento de Terapia Neurointensiva. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationCharité-Universitätsmedizin Berlin. Departamento de Nefrologia e Terapia Intensiva. Berlin, Germany.pt_BR
AffilliationInstituto D'Or de Pesquisa e Educação. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil / Instituto D'Or de Pesquisa e Educação. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationUniversity of Florida College of Medicine. Department of Neurology. Gainesville, FL, USA.pt_BR
AffilliationBoston University School of Medicine. Department of Neurology. Boston, MA, USA.pt_BR
AffilliationPontifícia Universidade Católica do Rio de Janeiro. Departamento de Engenharia Industrial. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationHospital Estadual Alberto Torres. UTI. São Gonçalo, SP, Brasil.pt_BR
AffilliationHospital Samaritano. UTI. São Paulo, SP, Brasil.pt_BR
AffilliationHospital Barra D'Or. UTI. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationHospital Municipal Souza Aguiar. UTI. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationHospital de Câncer do Maranhão Tarquínio Lopes Filho. UTI. São Luís, MA, Brasil.pt_BR
AffilliationHospital Unimed Costa do Sol. UTI. Macaé, RJ, Brasil.pt_BR
AffilliationHospital Estadual Getúlio Vargas. UTI. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationHospital Estadual Adão Pereira Nunes. UTI. Duque de Caxias, RJ, Brasil / Hospital Estadual Carlos Chagas. UTI. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationHospital Agenor Paiva. UTI. Salvador, BA, Brasil.pt_BR
AffilliationUniversidade Federal de Minas Gerais. Hospital das Clínicas. Serviço de Emergência. UTI. Belo Horizonte, MG, Brasil.pt_BR
AffilliationHospital Universitário Lauro Wanderley. UTI. João Pessoa, PB, Brasil.pt_BR
AffilliationClínica São Vicente. UTI. Rio de Janeiro, RJ, Brasil.pt_BR
AffilliationInstituto D'Or de Pesquisa e Educação. Departamento de Medicina Intensiva. Rio de Janeiro, RJ, Brasil.pt_BR
SubjectCardiac arrestpt_BR
SubjectCritical carept_BR
SubjectHeart arrestpt_BR
SubjectOutcomes assessmentpt_BR
SubjectTargeted temperature managementpt_BR
SubjectTherapeutic hypothermiapt_BR


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