Nevertheless, good neurological outcome at hospital discharge is

Nevertheless, good neurological outcome at hospital discharge is reasonably the more relevant endpoint.Ventricular fibrillation/pulseless ventricular tachycardia as first ECG rhythmIn OHCA patients with VF/pVT as the first ECG rhythm, we found an increased 24-hour survival and a better neurological selleck Bosutinib outcome at hospital discharge. An initial shockable ECG rhythm thus had a substantial influence on patient outcome. This result is in agreement with other studies [24-27]. The prevalence of VF/pVT as first rhythm has decreased in recent years, however, from 34% to 21% dependent on witnessing cardiac arrest and bystander CPR [28-32], but plausible explanation has not yet been found for this observation.

Patient ageAlthough young adults are a minority among patients suffering from OHCA, these victims suffer from this catastrophic event when they are in a very active phase of life with a long life expectancy. Our registry analysis confirmed that patients aged <60 years had a better outcome in terms of good neurological outcome. We assume that most of the younger patients do not suffer from significant co-morbidities, and that the motivation of the medical team may be highest in these younger adults to make greatest efforts on any therapeutic option within the postresuscitation care period [33].Mild therapeutic hypothermiaMTH is currently a mainstay of postresuscitation care [6-9,34]. Most clinical investigations, however, mainly included patients with VF/pVT as the first ECG rhythm, reporting good neurological outcome in this subset of patients.

In our database, MTH was associated with increased 24-hour survival. Interestingly, these favorable effects were observed irrespective of the initial ECG rhythm; the 24-hour survival rate was 92% in patients with VF/pVT and 90% in those with an initial nonshockable rhythm. More interestingly, 24-hour survival regarding hypothermia is rather questionable since the cooling therapy itself was still ongoing. Although 24-hour survival is mentioned as a core variable in the original Utstein style, it is still recommended as supplementary data in the Utstein update [20], and therefore should be reported as a clinical endpoint in these kinds of resuscitation registry analyses. Being aware of this limitation, we further analyzed survival and the proportion of patients with good neurological outcome at hospital discharge as the more relevant primary endpoint.

MTH was associated with increased good neurological outcome at hospital discharge in patients without PCI.Coronary interventionFor the treatment of noncardiac arrest patients with myocardial ischemia, PCI is currently Carfilzomib considered the treatment of first choice. But acute myocardial ischemia subsequent to coronary artery occlusion is also a common pathological correlate in cardiac arrest patients [35].

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