PMID- 19919982 OWN - NLM STAT- MEDLINE DCOM- 20091203 LR - 20091120 IS - 1941-3297 (Electronic) IS - 1941-3289 (Linking) VI - 2 IP - 6 DP - 2009 Nov TI - Factors associated with neurologically intact survival for patients with acute heart failure and in-hospital cardiac arrest. PG - 572-81 LID - 10.1161/CIRCHEARTFAILURE.108.828095 [doi] AB - BACKGROUND: Hospitalized patients with heart failure are at risk for cardiac arrest. The ability to predict who may survive such an event with or without neurological deficit would enhance the information on which patients and providers establish resuscitative preferences. METHODS AND RESULTS: We identified 13 063 adult patients with acute heart failure who had cardiac arrest at 457 hospitals participating in the National Registry of Cardiopulmonary Resuscitation between January 1, 2000 and December 31, 2007. Neurological status was determined on admission and discharge by cerebral performance category with neurologically intact survival (NIS)=cerebral performance category 1 (no) or 2 (moderate dysfunction) and non-NIS=cerebral performance category 3 (severe dysfunction), 4 (coma), or 5 (brain death). Factors available prearrest (demographics, preexisting conditions, and interventions in-place) were assessed for association with NIS using multivariable logistic regression, initially without then with adjustment for arrest-related variables and hospital characteristics. NIS occurred in 2307 patients (17.7%) and was associated by adjusted odds ratio with 18 prearrest factors; 4 positively and 14 negatively. The association (odds ratio; 95% CI) was strongest for 4 specific variables: acute stroke (0.38; 0.25 to 0.58), history of malignancy (0.49; 0.39 to 0.63), vasopressor use (0.50; 0.43 to 0.59), and assisted or mechanical ventilation (0.53; 0.45 to 0.61). CONCLUSIONS: A number of prearrest factors seem to be associated with NIS, the majority inversely. Consideration of these before cardiac arrest could enhance the resuscitative decision-making process for patients with acute heart failure. FAU - Levy, Phillip D AU - Levy PD AD - Department of Emergency Medicine and the Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan, USA. plevy@med.wayne.edu FAU - Ye, Hong AU - Ye H FAU - Compton, Scott AU - Compton S FAU - Chan, Paul S AU - Chan PS FAU - Larkin, Gregory Luke AU - Larkin GL FAU - Welch, Robert D AU - Welch RD CN - American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators LA - eng PT - Journal Article PT - Multicenter Study DEP - 20090928 PL - United States TA - Circ Heart Fail JT - Circulation. Heart failure JID - 101479941 SB - IM MH - Acute Disease MH - Aged MH - Aged, 80 and over MH - Brain/*physiopathology MH - *Cardiopulmonary Resuscitation MH - Disability Evaluation MH - Female MH - Heart Arrest/*etiology/mortality/physiopathology/therapy MH - Heart Failure/*complications/mortality/physiopathology MH - Humans MH - *Inpatients/statistics & numerical data MH - Logistic Models MH - Male MH - Middle Aged MH - Nervous System Diseases/*etiology/mortality/physiopathology MH - Odds Ratio MH - Patient Selection MH - Registries MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Survival Analysis MH - Treatment Outcome MH - United States/epidemiology FIR - Mader, Tim IR - Mader T FIR - Kern, Karl B IR - Kern KB FIR - Warren, Sam IR - Warren S FIR - Nichol, Graham IR - Nichol G FIR - Noel, Thomas IR - Noel T FIR - Ornato, Joseph P IR - Ornato JP FIR - Peberdy, Mary Ann IR - Peberdy MA FIR - Geocadin, Romergryko IR - Geocadin R FIR - Braithwaite, Scott IR - Braithwaite S FIR - Mancini, Mary E IR - Mancini ME FIR - Berg, Robert A IR - Berg RA FIR - Allen, Emilie IR - Allen E FIR - Duncan, Kathy IR - Duncan K FIR - Nadkarni, Vinay M IR - Nadkarni VM FIR - Larkin, Gregory Luke IR - Larkin GL FIR - Gosbee, John IR - Gosbee J FIR - Mears, Greg IR - Mears G FIR - Hunt, Elizabeth A IR - Hunt EA FIR - Truitt, Tanya Lane IR - Truitt TL FIR - Kaye, William IR - Kaye W FIR - Smyth, Melinda IR - Smyth M FIR - Potts, Jerry IR - Potts J FIR - Eigel, Brian IR - Eigel B FIR - Chan, P IR - Chan P FIR - Allen, E IR - Allen E FIR - Berg, S IR - Berg S FIR - Braithwaite, S IR - Braithwaite S FIR - Eigel, B IR - Eigel B FIR - Geocadin, R IR - Geocadin R FIR - Hunt, E IR - Hunt E FIR - Kern, K IR - Kern K FIR - Larkin, G IR - Larkin G FIR - Mader, T IR - Mader T FIR - Mancini, M IR - Mancini M FIR - Nadkarni, V IR - Nadkarni V FIR - Nichol, G IR - Nichol G FIR - Noel, T IR - Noel T FIR - Ornato, J IR - Ornato J FIR - Peberdy, M IR - Peberdy M FIR - Potts, J IR - Potts J FIR - Truitt, T IR - Truitt T FIR - Warren, S IR - Warren S EDAT- 2009/11/19 06:00 MHDA- 2009/12/16 06:00 CRDT- 2009/11/19 06:00 PHST- 2009/11/19 06:00 [entrez] PHST- 2009/11/19 06:00 [pubmed] PHST- 2009/12/16 06:00 [medline] AID - CIRCHEARTFAILURE.108.828095 [pii] AID - 10.1161/CIRCHEARTFAILURE.108.828095 [doi] PST - ppublish SO - Circ Heart Fail. 2009 Nov;2(6):572-81. doi: 10.1161/CIRCHEARTFAILURE.108.828095. Epub 2009 Sep 28.