Short and long-term outcomes among patients with and without psychiatric disorders following out-of-hospital cardiac arrest.
Heart rhythm · 2026-05-05 · Registry study
Abstract
BACKGROUND: Current literature lacks comprehensive data on the characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in patients with psychiatric disorders. OBJECTIVE: To assess the association between pre-hospital OHCA-characteristics and post-OHCA survival according to pre-OHCA psychiatric status. METHODS: We classified adult patients with non-traumatic OHCA in the British Columbia Cardiac Arrest registry (2009-2016) according to whether they had a pre-OHCA psychiatric disorder. We used multiple logistic regression, examining the full cohort and within Utstein-defined subgroups. RESULTS: Among 9173 OHCAs (median age 70 years, 67% male), 4438 (46%) had a pre-existing psychiatric disorder. In adjusted analyses, patients with psychiatric disorders were associated with lower odds of OHCA in public locations (odds ratio [OR]: 0.64, 95% confidence interval [CI], 0.57-0.73), witnessed OHCA (OR: 0.75 [CI, 0.69-0.82]), bystander cardiopulmonary resuscitation (OR: 0.86 [CI, 0.79-0.95]), bystander applied AED (OR: 0.56 [CI, 0.41-0.77]) or initial shockable rhythm (OR: 0.54 [CI, 0.49-0.61]) compared with patients without psychiatric disorders. Psychiatric disorders were associated with lower odds of 30-day post-OHCA survival (OR: 0.72, [CI, 0.63-0.82]) compared with patients without psychiatric disorders. However, among those with bystander-witnessed OHCA who received cardiopulmonary resuscitation (OR: 1.04 [CI, 0.79-1.34]) and those with initial shockable rhythm who achieved return of spontaneous circulation upon hospital arrival (OR: 0.89 [CI, 0.70-1.13]), we did not detect an association between psychiatric disorders and 30-day survival. CONCLUSION: Pre-existing psychiatric disorders are associated with lower odds of 30-day OHCA survival, primarily because of unfavorable pre-hospital factors, including limited bystander intervention.