Association of prehospital acetylsalicylic acid and heparin administration with favorable neurological outcome after out
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LETTER
Association of prehospital acetylsalicylic acid and heparin administration with favorable neurological outcome after out‑of‑hospital cardiac arrest: a matched cohort analysis of the German Resuscitation Registry Ulrich Grabmaier1,2* , Konstantinos D. Rizas1, Steffen Massberg1,2, Ludwig Weckbach1,2, Matthias Fischer3* and the German Resuscitation Registry Study Group © 2020 The Author(s)
Dear Editor, Out-of-hospital cardiac arrest (OHCA) is associated with high morbidity and mortality. Only approximately 5–14% of patients who survive OHCA are discharged with favorable neurological outcome [1, 2]. No prehospitally administered drug has shown to improve neurological outcome in these patients. Acute myocardial infarction (AMI) is a major cause of OHCA. We recently found AMI in 48.2% of patients with OHCA and showed that prehospital administration of acetylsalicylic acid and heparin (AH) was associated with improved survival to hospital discharge, particularly in patients with AMI [3]. In this study, we evaluated the effect of prehospital AH administration on favorable neurological outcome after OHCA. Using data from the nationwide, prospective German Resuscitation Registry, we retrospectively analyzed 17,948 patients with a resuscitation attempt and a presumed cardiac or unknown cause of OHCA between 2013 and 2018. The consort flow-diagram for the study population is depicted in Figure S1. Patients with prehospital AH administration were matched in a 1:3 ratio *Correspondence: [email protected]‑muenchen.de; matthias. fischer@af‑k.de 1 Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany 3 Department of Anaesthesiology and Intensive Care (DGAI), Klinik am Eichert, ALB FILS KLINIKEN GmbH, Postfach 660, 73006 Göppingen, Germany Full author information is available at the end of the article Ludwig Weckbach and Matthias Fischer share senior authorship.
with patients not treated with AH. The primary outcome was favorable neurological outcome at hospital discharge defined as cerebral performance category (CPC) 1 or 2. Secondary outcomes were return of spontaneous circulation (ROSC), ROSC at hospital admission, 24-h survival and survival to hospital discharge. Additional details can be found in the supplementary material. In the matched cohort comprising 203 patients with and 609 patients without prehospital AH administration, baseline characteristics were comparable between groups (Table 1). Differences between the matched cohort and the full cohort are shown in Table S1. Prehospital AH administration was associated with favorable neurological outcome (OR 2.25 (1.31–3.87), p = 0.003, Table S2). Patients with AH were more likely to gain ROSC (OR 2.22 (1.45–3.42), p 80 years (%)
18.7
18.7
18.7
1.000
Male sex (%)
71.3
67
72.7
0.117
100
100
100
1.000
Relevant preexisting illness
33
33
33
1.000
No or little preexisting illness
63.1
63.1
63.1
1.000
Unknown pre-emergency status
3.9
3.9
3.9
1.000
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