Association between pre-arrest left ventricular ejection fraction and survival in nontraumatic out-of-hospital cardiac arrest

Yi-Ju Ho; Chun-Ju Lien; Ren-Jie Tsai; Cheng-Yi Fan; Chi-Hsin Chen; Chien-Tai Huang; Ching-Yu Chen; Yun-Chang Chen; Chun-Hsiang Huang; Wen-Chu Chiang; Chien-Hua Huang; Chih-Wei Sung; Edward Pei-Chuan Huang

doi:10.1097/MEJ.0000000000001181

Association between pre-arrest left ventricular ejection fraction and survival in nontraumatic out-of-hospital cardiac arrest

Eur J Emerg Med. 2024 Sep 16. doi: 10.1097/MEJ.0000000000001181. Online ahead of print.

Authors

Yi-Ju Ho¹, Chun-Ju Lien², Ren-Jie Tsai², Cheng-Yi Fan², Chi-Hsin Chen², Chien-Tai Huang², Ching-Yu Chen³, Yun-Chang Chen³, Chun-Hsiang Huang², Wen-Chu Chiang^{3

4}, Chien-Hua Huang^{1

4}, Chih-Wei Sung^{2

4}, Edward Pei-Chuan Huang^{1

2

4}

Affiliations

¹ Department of Emergency Medicine, National Taiwan University Hospital, Taipei.
² Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.
³ Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin.
⁴ Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

PMID: 39283737
DOI: 10.1097/MEJ.0000000000001181

Abstract

Background and importance: Out-of-hospital cardiac arrest (OHCA) poses major public health issues. Pre-arrest heart function is a prognostic factor, but the specific contribution of pre-arrest echocardiographic evaluation in predicting OHCA outcome remains limited.

Objective: The primary objective was to investigate the association between left ventricular ejection fraction (LVEF) measured in echocardiography prior to OHCA and survival to hospital discharge.

Design, settings, and participants: This multicenter retrospective cohort study analyzed data from the National Taiwan University Hospital and its affiliated hospitals. We included adult nontraumatic OHCA patients who were treated by the emergency medical services (EMS) and underwent echocardiography within 6 months prior to the OHCA event from January 2016 to December 2022. Data included demographics, preexisting diseases, resuscitation events, and echocardiographic reports.

Outcomes measure and analysis: The primary outcome was the survival to hospital discharge after post-arrest care. Statistical analysis involved multivariable logistic regression to modify potential confounders, reported as adjusted odds ratio (aOR) and 95% confidence interval (CI), and evaluate the association between echocardiographic findings and survival to hospital discharge.

Main results: This study analyzed 950 patients, with 33.6% surviving to discharge. A higher pre-arrest LVEF was independently associated with increased survival. Compared to patients with LVEF < 40%, those with LVEF between 40% and 60% had significantly higher odds of survival (aOR = 3.68, 95% CI = 2.14-6.35, P < 0.001), and those with LVEF > 60% had even greater odds of survival (aOR = 5.46, 95% CI = 3.09-9.66, P < 0.001). There was also an association between lower tricuspid regurgitation pressure gradient and survival (aOR = 0.98, 95% CI = 0.97-1.00, P = 0.015). Younger age, male gender, dyslipidemia, stroke, cancer, witnessed arrest, initial shockable rhythm, and shorter low-flow time are other significant predictors of survival.

Conclusion: In adult, nontraumatic, EMS-treated OHCA patients, a higher LVEF 6 months prior to OHCA was associated with improved survival at hospital discharge.