Clinical Outcomes of Out-of-Hospital Cardiac Arrest with ROSC: Insights from a Specialized Referral Center in Vietnam.

Abstract

Background: Anti-N-Out-of-hospital cardiac arrest (OHCA) remains a condition with high morbidity and mortality despite advancements in resuscitation strategies. Identifying prognostic factors in OHCA patients who achieve a return of spontaneous circulation (ROSC) is critical for optimizing post-resuscitation care and improving survival outcomes.

Objective: This study evaluates clinical outcomes and predictors of in-hospital mortality in OHCA patients admitted to a tertiary referral center in Southern Vietnam.

Methods: A retrospective cohort study was conducted on OHCA patients with ROSC admitted to Cho Ray Hospital, Ho Chi Minh City, Vietnam, from January 1, 2019, to June 15, 2024. Demographic characteristics, clinical variables, and survival outcomes were analyzed. Predictors of in-hospital mortality were identified through multivariate logistic regression.

Results: Among 482 OHCA cases, 86 patients met the inclusion criteria. The mean age was 49.1 ± 17.2 years, with a male predominance (79.1%, male-to-female ratio: 3.8:1). Most cardiac arrests were witnessed (84.9%), and 32.5% presented with an initial shockable rhythm. Cardiac etiology was the predominant cause (67.4%). The overall in-hospital survival rate was 44.2%, with 25.6% achieving good neurological outcomes (Cerebral Performance Category [CPC] 1-2). Multivariate analysis identified lower Glasgow Coma Scale (GCS) scores (OR 1.42, 95% CI 1.01-2.00, p = 0.045), decreased estimated glomerular filtration rate (eGFR) (OR 1.03, 95% CI 1.00-1.06, p = 0.042), and higher cumulative epinephrine dose (OR 1.10, 95% CI 1.01-1.19, p < 0.05) as independent predictors of mortality. A predictive model incorporating these variables demonstrated strong discriminatory performance (AUC = 0.91). An epinephrine threshold of 7 mg was identified as a predictor of in-hospital mortality, with a sensitivity of 0.68 and specificity of 0.91.

Conclusion: In OHCA patients with ROSC, the in-hospital survival rate was 44.2%, with 25.6% achieving good neurological outcomes (CPC 1-2). Lower GCS scores, reduced eGFR, and higher total epinephrine doses were independently associated with increased mortality. These findings underscore the need for early risk stratification and individualized post-resuscitation management to improve patient outcomes.