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Giving plenty of in-hospital intensive care is believed critical to improve the overall outcomes of admitted out-of-hospital cardiac arrest (OHCA) victims. At least 96 hours of Intensive Care Unit (ICU) stay has been clinically recommended for admitted OHCA patients. However, the appropriate duration of ICU stay for hospitalized OHCA patients is still lack of clinical evidence and thus remains unknown. In this study, we described demographics, episode characteristics, key interventions, and outcomes of hospitalized OHCA patients in ROC Primed ALVE study, who stayed in ICU > 4 days or ≤4 days.
A secondary, retrospective analysis was performed on all hospitalized non-traumatic OHCA cases ≥18 years old with complete data report, who were enrolled in ROC Primed ALVE study between 2007- 2009. We reported the duration of ICU stay, survival to hospital discharge and favorable neurological outcomes for each case. Univariate and multivariate regression analysis assessed the association between ICU stay and survival as well as favorable neurological outcome.
Included were 3515 hospitalized OHCA cases; Medium (IQR) duration of ICU stay was 4(2, 8) days. Of them, 43.4% (1527) stayed in ICU > 4 days, while 56.6% (1988) stayed in ICU≤4 days; Of those who stayed in ICU > 4 days, 56.8% (867) survived to hospital discharge, and 40.6% (620)were discharged with favorable neurological outcome; However, of those who stayed in ICU≤4 days,18.8% (373) survived to hospital discharge, and 16% (318)were discharged with favorable neurological outcome. Further analysis showed that for every 1 day increase in ICU stay, the unadjusted and adjusted odds ratios for survival to hospital discharge were 1.149(95%CI 1.132-1.167, p=0.000) and 1.139(95%CI 1.113-1.165, p=0.000); and for favorable neurological outcome they were 1.055(995%CI 1.044-1.067, p=0.000) and 1.007(95%CI 0.992-1.022, p=0.347), respectively.
In ROC Primed ALVE study, 43.4% of hospitalized OHCA victims stayed in ICU for more than 4 days, which was independently associated with increased survival to hospital discharge. Longer ICU stay may also improve favorable neurological outcome, but this difference was not significant after adjustment for multiple variables.