Predictors of Resuscitation Outcomes with Global Assessment of Neurologic Status and Overall Survival in Sudden Cardiac Arrest (PROGNOSIS Cardiac Arrest): A Prospective Cohort Study

INTRODUCTION: Global survival rates from out-of-hospital cardiac arrest (OHCA) remain poor, particularly in the Asian region. Literature on OHCA in the Philippines is limited. Better characterization of outcomes of patients with OHCA and predictors of improved survival may help improve the management of OHCA. This study aimed to determine the clinical profiles of patients who had OHCA and identify predictors of survival. Methods: This was a single-center, prospective cohort study that included adult patients who had OHCA and brought to the Philippine Heart Center emergency room (ER) from May 2016 to September 2017. The clinical profiles and Utstein-based factors of cardiac arrest were collected and tabulated. The study outcomes were survival at 20 minutes, 24 hours, seven days and 30 days. Predictors of survival were determined using binary logistic regression. Results: Two hundred nine patients were included in the study, with a mean age of 62 ± 16.8 years. Majority were males, had witnessed arrest, had OHCA that occurred during morning hours at the place of residence and had comorbidities. Only 12% received pre-hospital cardiopulmonary resuscitation (CPR) and <1% had automated external defibrillator (AED) administration. The most common initial rhythm was asystole. The mean arrest-to-hospital and initial-in-hospital CPR duration were 25 minutes and 30 minutes, respectively. The survival rate was 26.3% at 20 minutes, 12.0% at 24 hours, 4.8% at 7 days and 2.4% at 30 days. Neurologic outcome was poor across all time intervals. Predictors of survival at 20 minutes included initial rhythm of ventricular fibrillation (VF) (OR 6.64; 95% CI 1.56-28.17; p=0.010), arrest-to-hospital arrival time interval ≤10 minutes (OR 12.02; 95% CI 4.12-35.06; p≤0.001) and initial-in-hospital CPR duration ≤20 minutes (OR 33.89; 95% CI 12.43-92.42; p≤0.001). Conclusion: Overall survival rates of OHCA remain dismal and were associated with poor neurologic outcomes. Initial rhythm of VF, arrest-to-hospital arrival time interval of ≤ 10 minutes, and initial-in-hospital CPR duration of ≤ 20 minutes were positive predictors of survival. Keywords: Sudden cardiac arrest, OHCA, survival predictors, PROGNOSIS.