P1356A nationwide study: Differences in use of neurological prognostication procedures in out-of-hospital cardiac arrest patients in intensive care units from 2004-2013

Abstract

Introduction: Neurological prognostication is an essential part of postresuscitation care of comatose out-of-hospital cardiac arrest (OHCA) patients. The European resuscitation guidelines state that no single prognostication procedure reliably predicts neurological outcome in patients comatose after OHCA. Aim(s): To evaluate differences in use of computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, electroencephalography (EEG), somatosensory evoked potentials (SSEP) in OHCA patients admitted to intensive care units (ICU) between 2004 and 2013 in Denmark. Method(s): We used the Danish Cardiac Arrest Registry to identify 3,213 oneday survivors of OHCA of presumed cardiac aetiology and >=18 years admitted to intensive care units. Procedures within 20 days post-arrest were considered related to the OHCA. Time trends were assessed by multiple logistic regression using 2004 as reference adjusting for prehospital and demographics factors. Result(s): Utilization of CT increased from 46% in 2004 to 63% in 2013 (fig 1). Use of acute CT (<24 hours from OHCA) increased from 29% to 40% in 2013. MRI was not used in 2004 but in 2013, 4% of patients were examined with MRI. EEG and SSEP also both increased from 0 to 32% and 14%, respectively. Use of mechanical ventilation also increased from 74% to 93% between 2004 and 2013. Annual increase rates (OR) increased for all procedures, see Figure 1 Use of prognostication procedure varied between health care regions (p<0.001 for all), but no consistent associations with demographic (age, sex), sociodemographic (annual income, educational level) and prehospital factors (shockable rhythm, public arrest, bystander CPR) was found Even after adjusting for age, sex, primary rhythm, arrest in public places, bystander CPR, health care region of arrest, educational level, income, coronary angiography (CAG) <24 hours post OHCA and CAG >24 hours post OHCA, the use of CT, MR, SSEP, EEG and mechanical ventilation increased during the study period (pr. 1 year increase), fig. 1 (ORCT: 1.07, CI: 1.04-1.09, p<0.001, ORMR: 1.21, CI: 1.09-1.34, p=0.0002, ORSSEP: 1.34, CI: 1.25-1.43, p<0.001, OREEG: 1.34, CI: 1.27-1.39, p<0.001, ORventilation: 1.11, CI: 1.05-1.17, p=0.001). Conclusion(s): Neurological prognostication procedures are increasingly applied in out-of-hospital cardiac arrest patients admitted in intensive care units in Denmark in accordance with guideline recommendations.