(280) Epidemiology and Outcomes in OHCA Patients Without Coma After Return of Spontaneous Circulation

Introduction: There are no reports available specifically on out-of-hospital cardiac arrest (OHCA) patients without coma after return of spontaneous circulation (ROSC).

Methods: This study was a secondary analysis of data from the JAAM-OHCA Registry. Adult OHCA patients without coma after ROSC between June 2014 to December 2019 were included. Without coma patients was defined as a Glasgow coma scale ≥ 8 after ROSC. Primary endpoint was 1-month unfavorable neurological outcome. An unfavorable neurological outcome was defined as a Glasgow-Pittsburgh Cerebral Performance Category (CPC) score of 3–5. We conducted a classification and regression tree (CART) analysis for primary endpoint using selected several factors as explanatory variables according to multivariable logistic regression analysis.

Results: This study included 875 patients. The proportion of 1-month unfavorable neurological outcomes was 24.0% (n = 210), and 1-month mortality was 13.6% (n = 119). Multivariable analysis revealed that age, lactate level after ROSC, initial non-shockable rhythm and lower GCS motor score were significantly associated with 1-month unfavorable outcome (P < 0.05). According to the CART model, among the patients who followed commands (GCS motor score = 6) after ROSC, the predicted probability of an unfavorable outcome was 86.9% in patients who were older (age ≥ 57 years) and had a shockable rhythm with high lactate levels (lactate ≥ 129 mg/dL). Additionally, among the patients who followed commands after ROSC, the predicted probability of an unfavorable outcome was 73.7% in patients who were older (age ≥ 57 years) and had a non-shockable rhythm with high lactate levels (lactate ≥ 105 mg/dL).

Conclusions: This study provided an overview of OHCA patient without coma after ROSC. The proportion of 1-month unfavorable neurological outcomes and mortality were 24.0%, and 16.9%, respectively. Even if the patient followed commands after ROSC, the patients could be a poor outcome if certain conditions are met.