Comparison of neurological outcomes between out-of-hospital cardiac arrest due to anaphylaxis and cardiac causes: a nationwide population-based observational study

BMJ Open. 2024 Dec 31;14(12):e089500. doi: 10.1136/bmjopen-2024-089500.

Abstract

Objective: To compare the neurological outcomes of out-of-hospital cardiac arrest due to anaphylaxis (OHCA-A) and cardiac causes (OHCA-C).

Design: Retrospective observational study.

Setting: Japanese nationwide dataset from 2012 to 2021.

Participants: In total, 153 890 patients were included in this study, of which 331 had OHCA-A and 153 559 had OHCA-C.

Outcome measures: The primary outcome was a favourable neurological outcome 1 month after cardiac arrest. The secondary outcome was survival at 1 month.

Results: Patients with OHCA-A had a significantly higher favourable neurological outcome rate (24.2% vs 11.7%, p<0.001) and higher survival rate at 1 month (33.2% vs 16.1%, p<0.001) than patients with OHCA-C. Multivariable logistic regression analysis revealed that OHCA-A was associated with higher odds of favourable neurological outcomes (adjusted OR (adj OR): 1.86; 95% CI 1.34 to 2.59) and survival at 1 month (adj OR: 2.43; 95% CI 1.78 to 3.31). Similarly, the propensity score-matched cohort showed favourable neurological outcomes in patients with OHCA-A (OR: 2.91; 95% CI 1.83 to 4.65).

Conclusion: Compared with OHCA-C, OHCA-A is associated with favourable neurological outcomes and warrants more aggressive resuscitation efforts.

Keywords: Cardiopulmonary Resuscitation; Emergency Service, Hospital; Out-of-Hospital Cardiac Arrest.

Publication types

  • Observational Study
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Anaphylaxis* / complications
  • Anaphylaxis* / epidemiology
  • Anaphylaxis* / etiology
  • Cardiopulmonary Resuscitation
  • Female
  • Humans
  • Japan / epidemiology
  • Logistic Models
  • Male
  • Middle Aged
  • Nervous System Diseases / complications
  • Nervous System Diseases / epidemiology
  • Nervous System Diseases / etiology
  • Out-of-Hospital Cardiac Arrest* / epidemiology
  • Out-of-Hospital Cardiac Arrest* / etiology
  • Out-of-Hospital Cardiac Arrest* / mortality
  • Propensity Score
  • Retrospective Studies
  • Survival Rate