Outcome of Out-of-Hospital Cardiac Arrest Patients Stratified by Pre-Clinical Loading with Aspirin and Heparin: A Retrospective Cohort Analysis

• Published in: Journal of clinical medicine Vol. 12; no. 11; p. 3817
• Main Authors: Macherey-Meyer, Sascha, Heyne, Sebastian, Meertens, Max M., Braumann, Simon, Niessen, Stephan F., Baldus, Stephan, Lee, Samuel, Adler, Christoph
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 02.06.2023; MDPI
• Subjects: Acute coronary syndromes; Anticoagulants; Anticoagulants (Medicine); Aspirin; Cardiac arrest; Cardiac patients; Cardiology; Cardiopulmonary resuscitation; Cardiovascular disease; Causes of; Clinical medicine; Cohort analysis; Coronary vessels; CPR; Drug therapy; Emergency medical care; Ischemia; Medical imaging; Medical prognosis; Patient outcomes; Patients; Statistics; Germany; heparin; STEMI; aspirin; NSTE-ACS; OHCA
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12113817

Background: Out-of-hospital cardiac arrest (OHCA) has a high prevalence of obstructive coronary artery disease and total coronary occlusion. Consequently, these patients are frequently loaded with antiplatelets and anticoagulants before hospital arrival. However, OHCA patients have multiple non-cardiac causes and high susceptibility for bleeding. In brief, there is a gap in the evidence for loading in OHCA patients. Objective: The current analysis stratified the outcome of patients with OHCA according to pre-clinical loading. Material and Methods: In a retrospective analysis of an all-comer OHCA registry, patients were stratified by loading with aspirin (ASA) and unfractionated heparin (UFH). Bleeding rate, survival to hospital discharge and favorable neurological outcomes were measured. Results: Overall, 272 patients were included, of whom 142 were loaded. Acute coronary syndrome was diagnosed in 103 patients. One-third of STEMIs were not loaded. Conversely, 54% with OHCA from non-ischemic causes were pretreated. Loading was associated with increased survival to hospital discharge (56.3 vs. 40.3%, p = 0.008) and a more favorable neurological outcome (80.7 vs. 62.6% p = 0.003). Prevalence of bleeding was comparable (26.8 vs. 31.5%, p = 0.740). Conclusions: Pre-clinical loading did not increase bleeding rates and was associated with favorable survival. Overtreatment of OHCA with non-ischemic origin, but also undertreatment of STEMI-OHCA were documented. Loading without definite diagnosis of sustained ischemia is debatable in the absence of reliable randomized controlled data.