Background: Out of hospital aborted sudden cardiac death (ASCD) frequently results in neurologic damage. Although the patients with ASCD and severe neurologic damage (ND) cause enormous socio-economic burden, the prognosis remains to be studied.
Methods and Results: We retrospectively reviewed the medical records of 70 patients with ASCD (male 81.4%, 52±17 years old, ventricular tachycardia/fibrillation 80.0%, asystole 20.0%), and followed up current status of the patients. The degree of ND was evaluated at 48 hour after admission by Glasgow coma scale and at 1week by ASCD-ND grade 0 (no ND), 1 (mild ND: independent daily activity (DA)), 2 (moderate ND, partially dependent DA), and 3 (severe ND, entirely dependent DA).
Results:
1. In patients with ASCD-ND grade 3 (n=22, 31.4%), arrest to return of spontaneous circulation time was longer (40.3±17.2 min vs. 17.3±11.7 min, p<0.001), 48hour Glasgow coma scale was lower (3.6±2.6 vs. 14.2±2.6, p<0.001), survival discharge rate was lower (63.6% vs. 100%, p<0.001), and 6-month survival rate was lower (35.3% vs. 100%, p<0.001) as compared with ASCD-ND grades 0 to 2 (n=48, 68.6%). In patients with ASCD-ND grade 3 with poor mentality (semicoma or coma, n=11, 15.7%), 6-month survival rate was 8.3%.
2. Comatose mentality at 48 hour (n=23) predicts 30.4% in-hospital mortality and 38.9% 6-month survival rate. In contrast, non-comatose mentality at 48 hour (n=43) was related with 100% survival discharge and 100% 6-month survival rate (p<0.001).
3. The patients with age > 70 years old showed significantly low survival discharge rate (63.6% vs. 94.9%, p=0.001) and 6-month survival rate (44.4% vs. 88.7%, p=0.001) than those < 70 years old.
Conclusion:
The prognosis of out of hospital ASCD was closely related to the degree of ND and age. Non-comatose mentality at 48 hour after admission predicts survival discharge and good prognosis. In contrast, ASCD-ND grade 3 with poor mentality at 1 week of admission was associated with very poor prognosis.
Key words : sudden cardiac arrest, neurologic outcome, survival
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