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J Korean Soc Emerg Med > Volume 29(1); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(1): 66-75.
Effect of Prothrombin Time Prolongation on Survival Outcome in Out-of-hospital Cardiac Arrest: A Multicenter Observational Study
Ki Hong Kim1, Sang Do Shin1, Kyoung Jun Song1, Young Sun Ro1, Ki Jeong Hong2, Sae Won Choi,1
1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
2Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
Correspondence  Sang Do Shin ,Tel: 02-2072-3257, Fax: 02-741-7855, Email: sdshin@snu.ac.kr,
Received: January 9, 2018; Revised: January 9, 2018   Accepted: January 12, 2018.  Published online: February 28, 2018.
This study examined the association between the prothrombin time (PT) prolongation during cardiopulmonary resuscitation (CPR) and the outcome after an out-of-hospital cardiac arrest (OHCA).
From the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance database, CPR-attempted and adult OHCAs with a cardiac etiology transported to emergency departments (EDs) from January to December 2014 were included. The PT was measured immediately after arrival to the ED during CPR, and PT prolongation was categorized into 3 groups, the normal group (international normalized ratio [INR]<1.1), mild group (1.1≤INR<1.4), and severe group (1.4≤INR). The primary and secondary outcomes were survival to hospital discharge and a good cerebral performance scale (CPC) of 1 or 2. The potential confounders were adjusted for calculating the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) in multivariable logistic regression analysis.
The survival and good CPC rates were 17.2% and 11.8% in the normal group, 12.2% and 4.5% in the mild group, and 3.6% and 0.6% in the severe group, respectively (p<0.01). The AORs (95% CIs) on survival were 0.72 (0.41 to 1.27) for the mild group and 0.28 (0.11 to 0.69) for the severe group. The AORs (95% CIs) for good CPC were 0.41 (0.19 to 0.91) for the mild group and 0.14 (0.02 to 0.83) for the severe group.
The PT prolongation measured at the ED was found to be associated with poor outcomes in adult OHCAs with cardiac etiology.
Key words: Prothrombin time, Out-of-hospital cardiac arrest, Survival
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