Abstract
Introduction
Chronic obstructive pulmonary disease (COPD) is associated with a non-shockable rhythm
as presenting rhythm in out-of-hospital cardiac arrest (OHCA). Whether the severity
of the underlying disease is related to presenting rhythm is unknown. We hypothesized
that increased severity of COPD in OHCA patients is associated with an increased prevalence
of non-shockable rhythm.
Methods
This study included OHCA patients ≥40 years from the Danish Cardiac Arrest Registry
(2001–2014). Population-based registries were used to identify chronic diseases and
drug prescriptions. COPD was defined as a COPD diagnosis or pharmacological therapy
for COPD. The severity of COPD was based on either 1) pharmacological therapy (mild/moderate/severe),
2) admission for exacerbation, 3) prescription for corticosteroids, or 4) forced expiratory
volume in 1 s (FEV1). For each of these, a multivariable logistic regression model
was used to estimate odds ratios (ORs) for a non-shockable rhythm.
Results
Of 33,228 patients with OHCA 7789 (23.4%) had COPD. Of these 6702 (86.0%) had a non-shockable
rhythm. Compared to patients without COPD, mild COPD was associated with a non-shockable
rhythm (OR = 1.46, 95%CI 1.29–1.65). This association was more pronounced for moderate
(OR = 1.78, 95%CI 1.45–2.19) and severe COPD (OR = 2.01 95%CI 1.82–2.20). Recent admission
for exacerbation (OR = 2.12, OR 95%CI 1.81–2.49) or prescription for corticosteroids
(OR = 1.82, 95%CI 1.55–2.14) was also associated with a non-shockable rhythm. FEV1 ≤ 50%
was associated with a non-shockable rhythm compared to FEV1 > 50% (OR = 1.74, 95%CI
1.07–2.82, n = 1122).
Conclusion
Incremental severity of COPD is associated with increasing prevalence of a non-shockable
rhythm as presenting rhythm in OHCA patients.
Keywords
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Article info
Publication history
Published online: March 05, 2018
Accepted:
March 4,
2018
Received in revised form:
February 19,
2018
Received:
November 20,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.03.006.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.