Incidence and outcomes of rearrest following out-of-hospital cardiac arrest

Introduction: Rearrest occurs when a patient experiences cardiac arrest after successful resuscitation. The incidence and outcomes of rearrest following out-of-hospital cardiac arrest have been estimated in limited local studies. We sought provide a large-scale estimate of rearrest incidence and its effect on survival. Methods: We obtained case data from emergency medical services-treated, out-of-hospital cardiac arrest from the Resuscitation Outcomes Consortium, a multi-site clinical research network with clinical centers in 11 regions in the US and Canada. The cohort comprised all cases captured between 2006 and 2008 at 10 of 11 regions with prehospital return of spontaneous circulation. We used three methods to ascertain rearrest via direct signal analysis, indirect signal analysis, and emergency department arrival vital status. Rearrest incidence was estimated as the proportion of cases with return of spontaneous circulation that experience rearrest. Regional rearrest incidence estimates were compared with the X-2-squared test. Multivariable logistic regression was used to assess the relationship between rearrest and survival to hospital discharge. Results: Out of 18,937 emergency medical services-assessed cases captured between 2006 and 2008, 11,456 (60.5%) cases were treated by emergency medical services and 4396 (38.4%) had prehospital return of spontaneous circulation. Of these, rearrest ascertainment data was available in 3253 cases, with 568 (17.5%) experiencing rearrest. Rearrest differed by region (10.2% to 21.2%, p< 0.001). Rearrest was inversely associated with survival (OR: 0.19,95% CI: 0.14-0.26). Conclusions: Rearrest was found to occur frequently after resuscitation and was inversely related to survival. (C) 2014 Elsevier Ireland Ltd. All rights reserved.