SPC365

Clinical profile and outcomes of resuscitated cardiac arrest patients: a 10-year analysis of IHCA and OHCA comatose patients at a cardiac intensive care unit

Session: Sessão de Posters 40 - Pós-paragem cardíaca e desfechos na UCI cardíaca
Speaker: Margarida Urpina Matias

Congress: CPC 2026
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.5 Acute Cardiac Care – Cardiac Arrest
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Margarida Urpina Matias; Maria Inês Soares; Raquel Montalvão; Márcia Presume; João Machado; Ana Rita Bello; Mariana Sousa Paiva; João Presume; Jorge Ferreira; Catarina Brízido
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u>Background</u></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Sudden cardiac arrest (CA) remains a major public health concern with high morbimortality and economic burden. Despite improvements in pre- and in-hospital resuscitation protocols and expanding ECPR use, survival and neurological recovery remains limited.&nbsp;</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u>Purpose</u></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To describe clinical and event-related characteristics, and identify factors associated with poor neurologic and functional outcomes in comatose CA patients admitted to a cardiac intensive care unit (CICU).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u>Methods</u></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Retrospective analysis of consecutive comatose patients (GCS&lt;8) admitted to a CICU after resuscitation from in-hospital or out-of-hospital CA (IHCA or OHCA), between 2015-2025. Patients underwent multimodal neuroprognostication and were stratified according to probability of&nbsp; poor neurological outcome according to 2025 European Resuscitation Council (ERC) Guidelines. The primary outcome was neurological status at 30 days, using the Cerebral Performance Category (CPC) scale, categorizing patients as good (1&ndash;2) vs poor (3&ndash;5). Bivariate analyses were performed using Chi-Square and Mann-Whitney.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u>Results</u></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: 94 patients (mean age 62 &plusmn; 17 y, 70% male) were included; 32% had IHCA. Most OHCA were witnessed (90%) and 72% received bystander CPR. Mean no-flow time was 1.8, median low-flow time was 15 [8.5-18.8], and time to ROSC 25 [16-40] minutes. Post-ROSC care included TTM targeting normothermia in 62%, though 35% developed fever within 72 hours. According to ERC criteria, one third of 90 patients completing neuroprognostication were classified with poor neurological prognosis. At 30 days, 71% had CPC 3-5 and 62% died, mainly from early hemodynamic instability and multiorgan failure, and later from withdrawal of life-sustaining therapies.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Baseline features and comorbidities were similar across prognosis groups. Poor neuroprognosis and CPC 3-5 were more frequent in OHCA (96% vs 55%; </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>p= 0.0001</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">; and 76% vs 48%; </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>p=0</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">.008, respectively). Longer low-flow time correlated with poor ERC prognosis (</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>p=0.04</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">) and CPC 3-5 (</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>p=0.01)</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">, while no-flow and time-to-ROSC did not differ. Initial rhythm (shockable rhythm occurred in 65%, pulseless electrical activity in 26%), and ECPR use (10%, n=9) showed no association with outcomes.</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">STEMI on post-ROSC ECG was significantly linked to poor neuroprognosis (</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>p=0.02</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">). After admission, coronary revascularization and LVEF were not related to CPC or ERC neuroprognosis. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff">Fever during the first 72h </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#222222"><span style="background-color:#ffffff">occurred</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="background-color:#ffffff"> more frequently in patients with poor neuroprognosis, despite not meeting statistical significance</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> (50% vs 29%, </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><em>p=</em></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> 0.08).&nbsp;</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><u>Conclusion</u></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Despite rapid and mostly witnessed resuscitation, OHCA and longer low-flow time were consistently higher in patients with poor neuroprognosis and functional outcomes at 30 days. This study suggests pre-hospital conditions and primary cardiovascular prevention are still the main targets to improve post-CA outcomes</span></span></span></p>