Early antibiotics improve survival following out-of hospital cardiac arrest

Introduction

Therapeutic hypothermia (TH) has become standard management following out of hospital cardiac arrest (OHCA). Recent evidence suggests TH increases the incidence of pneumonia. We retrospectively assessed infective indicators after OHCA and evaluated the effect of antibiotics on survival.

Method

We identified all patients admitted to the ICU of a regional primary angioplasty hospital following OHCA from May 2007 to December 2010. We collected demographic and outcome data, evidence of infection and the use of antimicrobial therapy.

Results

138 patients were admitted to ICU following OHCA. The mortality rate was 68.1% with mean ICNARC predicted mortality of 77.5%. Of 138 patients, 135 (97.8%) had at least one positive marker of infection within 72 h.53 of 138 patients (38.4%) received antibiotics during the first 7 days of their ICU stay. The hospital mortality rate for these patients was significantly less than those not receiving antibiotics (56.6% vs. 75.3%; p = 0.025) with NNT of 5. Multivariate analysis demonstrated that antibiotic use was an independent predictor of survival.

Conclusion

The post-arrest management of OHCA is commonly complicated by infections, the accurate diagnosis of which is impaired by the associated increase in inflammatory markers, body temperature control, delay in the processing of samples and poor quality chest radiography.We have shown a significant reduction in mortality in patients who received antibiotics compared with patients who did not. This suggests that a formal clinical trial is warranted.