Presence of pulmonary hypertension in patients with out-of-hospital cardiac arrest was associated with significantly worse 30-day survival (3.9% vs 11.0%, p<0.001) compared to those without PH.
Observational (n=54,740)
Yes
Does the presence of pulmonary hypertension reduce survival in patients with out-of-hospital cardiac arrest?
Cardiopulmonary resuscitation in patients with pulmonary hypertension who experience out-of-hospital cardiac arrest is rarely successful, with significantly lower 30-day and 1-year survival compared to those without PH, though neurological outcomes among survivors are similar.
Effect estimate: HR 0.63 (95% CI 0.37-1.00)
Absolute Event Rate: 3.9% vs 11%
p-value: p=<0.001
Abstract Background: Patients with severe pulmonary hypertension (PH) often die of right ventricular failure or sudden cardiac death. There is very limited information on the outcome of cardiopulmonary resuscitation (CPR) in this patient group. In Sweden, approximately 6000 people are affected by out-of-hospital cardiac arrest (OHCA) yearly, with a 30-day survival rate of 10.5%. The prevalence and outcome of PH among these patients has not been previously investigated. Aim: To analyze the relationship between the presence of PH and survival (primary outcome) as well as neurological function, defined as cerebral performance score (secondary outcome), after OHCA in data from the Swedish Registry for Cardiopulmonary Resuscitation (SRCR). Methods: This study included 54 740 patients with OHCA reported to the SRCR between 2010 and 2020. Patients were categorized by the presence of PH and stratified by gender. Clinical characteristics and outcomes were studied using descriptive statistics, logistic, and Cox proportional regression. Results: PH was found in 1.8% (n=979) of the study cohort. PH patients were older (76 vs 69 years, p0.001), more often women (40.2 vs 33.8%, p0.001), and had more pronounced cardio-pulmonary comorbidity than the patients without PH. The initial rhythm was more often pulseless electric activity (28.1 vs 17.1%) or asystole (60.9 vs 59.3%), and less often ventricular fibrillation (11.1 vs 23.6%), p0.001, SMD 0.387. They had a worse 30 day- (3.9 vs 11%, p0.001, SMD) and one year-survival rate (1.7 vs 9.9%, p0.001), HR (95% CI) of 0.63 (0.37−1.00) compared to the patients without PH. ROSC was observed in 34% and 34.5% of the patients with/without PH, respectively. The cerebral performance category (CPC) was similar in the two-groups; 87.5% of the PH patients had no or mild sequelae (CPC score 1 or 2), compared to 91.1% of the ones without PH. No time-related trends in 30-days survival were found. In a propensity score matching analysis/nearest neighbor matching, the 30 day- and one year-survival of patients without PH were 6.0 and 5.2% respectively. Conclusion: Our data indicate that CPR in PH patients who experience OHCA is rarely successful. However, no significant difference in cerebral performance was observed between survivors with PH and those without.Survival by presence of PH
Hjalmarsson et al. (Sat,) conducted a observational in Out-of-hospital cardiac arrest (n=54,740). Presence of pulmonary hypertension vs. Absence of pulmonary hypertension was evaluated on 30-day survival (HR 0.63, 95% CI 0.37-1.00, p=<0.001). Presence of pulmonary hypertension in patients with out-of-hospital cardiac arrest was associated with significantly worse 30-day survival (3.9% vs 11.0%, p<0.001) compared to those without PH.