Clinical and laboratory predictors of 28-day survival and neurologic outcome in out-of-hospital cardiac arrest: A prospective cohort study.
Irish Journal of Medical Science · 2025-10-20 · Observational study
Abstract
BACKGROUND: Despite advances in prehospital and in-hospital management, only a small proportion of out-of-hospital cardiac arrest (OHCA) patients achieve survival with favorable neurological outcomes. AIMS: To identify clinical factors and laboratory parameters predictive of short-term survival and favorable neurological outcomes in OHCA. METHODS: This prospective, observational cohort enrolled consecutive adults with OHCA transported by emergency medical services to the emergency department (ED) of Haseki Training and Research Hospital (Istanbul) from May 2023 to 2024. Prehospital variables, ED clinical assessments, and admission laboratory parameters were recorded. Primary outcomes were return of spontaneous circulation (ROSC), 28-day survival, and neurological status at 28 days, assessed by the Cerebral Performance Category. Multivariable logistic regression was used to identify independent predictors of 28-day survival. RESULTS: Of the 327 patients, 41 (12.5%) survived to 28 days. Survivors were younger and more frequently had an initial shockable rhythm, prehospital defibrillation, and shorter no-flow time. On admission, they had higher pH and bicarbonate, and lower lactate. Among survivors, favorable neurological outcomes were associated with younger age, shorter no-flow time, shockable rhythm, and prehospital defibrillation. Independent predictors of 28-day survival included younger age, higher arterial pH, shockable rhythm, arrest outside the home, shorter no-flow duration, prehospital defibrillation, and absence of early vasopressor requirement. Prehospital endotracheal intubation (ETI) was not associated with improved survival compared with supraglottic airway. CONCLUSION: Shorter no-flow time, shockable rhythm, and prehospital defibrillation were strongly associated with survival and favorable neurological outcomes in OHCA. Admission arterial pH was the most informative laboratory predictor of short-term survival.
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Tags
Cardiovascular drugs · Endotracheal intubation · Mortality & survival · Other drugs · Quality of life & function · Sodium bicarbonate · Supraglottic airway · Vasopressors
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