Advanced

Atrial Fibrillation Following Out-of-Hospital Cardiac Arrest and Targeted Temperature Management - Are We Giving It the Attention it Deserves?

Thomsen, Jakob Hartvig; Hassager, Christian; Erlinge, David LU ; Nielsen, Niklas LU ; Horn, Janneke; Hovdenes, Jan; Bro-Jeppesen, John; Wanscher, Michael; Pehrson, Steen LU and Køber, Lars, et al. (2016) In Critical Care Medicine 44(12). p.2215-2222
Abstract

Objectives: Atrial fibrillation has been associated with increased mortality in the general population and mixed populations of critical ill. Atrial fibrillation can also affect patients during post-cardiac arrest care. We sought to assess the prognostic implications of atrial fibrillation following out-of-hospital cardiac arrest, including relation to the level of targeted temperature management. Design: A post hoc analysis of a prospective randomized trial. Setting: Thirty-six ICUs. Patients: We included 897 (96%) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial (year, 2010-2013) with data on heart rhythm on day 2. Interventions: Targeted temperature management at 33°C or... (More)

Objectives: Atrial fibrillation has been associated with increased mortality in the general population and mixed populations of critical ill. Atrial fibrillation can also affect patients during post-cardiac arrest care. We sought to assess the prognostic implications of atrial fibrillation following out-of-hospital cardiac arrest, including relation to the level of targeted temperature management. Design: A post hoc analysis of a prospective randomized trial. Setting: Thirty-six ICUs. Patients: We included 897 (96%) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial (year, 2010-2013) with data on heart rhythm on day 2. Interventions: Targeted temperature management at 33°C or 36°C. Measurements and Main Results: Endpoints included cumulative proportion of atrial fibrillation following out-of-hospital cardiac arrest and 180-day all-cause mortality and specific death causes stratified by atrial fibrillation. Atrial fibrillation on day 2 was used as primary endpoint analyses to exclude effects of short-term atrial fibrillation related to resuscitation and initial management. The cumulative proportions of atrial fibrillation were 15% and 11% on days 1 and 2, respectively. Forty-three percent of patients with initial atrial fibrillation the first day were reported with sinus rhythm on day 2. No difference was found between the groups treated with targeted temperature management at 33°C and 36°C. Patients affected by atrial fibrillation had significantly higher 180-day mortality (atrial fibrillation: 66% vs no-atrial fibrillation: 43%; plogrank < 0.0001 and unadjusted hazard ratio, 1.75 [1.35-2.30]; p < 0.0001). The association between atrial fibrillation and higher mortality remained significant (adjusted hazard ratio, 1.34 [1.01-1.79]; p < 0.05) adjusted for potential confounders. Atrial fibrillation was independently associated with increased risk of cardiovascular death and multiple-organ failure (adjusted hazard ratio, 2.07 [1.39-3.09]; p < 0.001), whereas no association with higher risk of death from cerebral causes was found. Conclusions: Atrial fibrillation was independently associated with higher mortality, primarily driven by cardiovascular causes and multiple-organ failure, and may thus identify a vulnerable subpopulation. Whether treatment to prevent atrial fibrillation is associated with an improved prognosis remains to be established.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
atrial fibrillation, cardiopulmonary resuscitation, comatose, mortality, out-of-hospital cardiac arrest, therapeutic hypothermia
in
Critical Care Medicine
volume
44
issue
12
pages
2215 - 2222
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:84995575849
  • wos:000388056500012
ISSN
0090-3493
DOI
10.1097/CCM.0000000000001958
language
English
LU publication?
yes
id
2c38ada7-da17-4f05-aaf5-f78fdfb35b41
date added to LUP
2016-12-05 10:18:55
date last changed
2017-09-18 11:30:00
@article{2c38ada7-da17-4f05-aaf5-f78fdfb35b41,
  abstract     = {<p>Objectives: Atrial fibrillation has been associated with increased mortality in the general population and mixed populations of critical ill. Atrial fibrillation can also affect patients during post-cardiac arrest care. We sought to assess the prognostic implications of atrial fibrillation following out-of-hospital cardiac arrest, including relation to the level of targeted temperature management. Design: A post hoc analysis of a prospective randomized trial. Setting: Thirty-six ICUs. Patients: We included 897 (96%) of the 939 comatose out-of-hospital cardiac arrest survivors from the targeted temperature management trial (year, 2010-2013) with data on heart rhythm on day 2. Interventions: Targeted temperature management at 33°C or 36°C. Measurements and Main Results: Endpoints included cumulative proportion of atrial fibrillation following out-of-hospital cardiac arrest and 180-day all-cause mortality and specific death causes stratified by atrial fibrillation. Atrial fibrillation on day 2 was used as primary endpoint analyses to exclude effects of short-term atrial fibrillation related to resuscitation and initial management. The cumulative proportions of atrial fibrillation were 15% and 11% on days 1 and 2, respectively. Forty-three percent of patients with initial atrial fibrillation the first day were reported with sinus rhythm on day 2. No difference was found between the groups treated with targeted temperature management at 33°C and 36°C. Patients affected by atrial fibrillation had significantly higher 180-day mortality (atrial fibrillation: 66% vs no-atrial fibrillation: 43%; p<sup>logrank</sup> &lt; 0.0001 and unadjusted hazard ratio, 1.75 [1.35-2.30]; p &lt; 0.0001). The association between atrial fibrillation and higher mortality remained significant (adjusted hazard ratio, 1.34 [1.01-1.79]; p &lt; 0.05) adjusted for potential confounders. Atrial fibrillation was independently associated with increased risk of cardiovascular death and multiple-organ failure (adjusted hazard ratio, 2.07 [1.39-3.09]; p &lt; 0.001), whereas no association with higher risk of death from cerebral causes was found. Conclusions: Atrial fibrillation was independently associated with higher mortality, primarily driven by cardiovascular causes and multiple-organ failure, and may thus identify a vulnerable subpopulation. Whether treatment to prevent atrial fibrillation is associated with an improved prognosis remains to be established.</p>},
  author       = {Thomsen, Jakob Hartvig and Hassager, Christian and Erlinge, David and Nielsen, Niklas and Horn, Janneke and Hovdenes, Jan and Bro-Jeppesen, John and Wanscher, Michael and Pehrson, Steen and Køber, Lars and Kjaergaard, Jesper},
  issn         = {0090-3493},
  keyword      = {atrial fibrillation,cardiopulmonary resuscitation,comatose,mortality,out-of-hospital cardiac arrest,therapeutic hypothermia},
  language     = {eng},
  month        = {12},
  number       = {12},
  pages        = {2215--2222},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Critical Care Medicine},
  title        = {Atrial Fibrillation Following Out-of-Hospital Cardiac Arrest and Targeted Temperature Management - Are We Giving It the Attention it Deserves?},
  url          = {http://dx.doi.org/10.1097/CCM.0000000000001958},
  volume       = {44},
  year         = {2016},
}