TY - JOUR

T1 - Use of torsades de pointes risk drugs among patients with out-of-hospital cardiac arrest and likelihood of shockable rhythm and return of spontaneous circulation

T2 - a nationwide study

AU - Krøll, Johanna

AU - H B Jespersen, Camilla

AU - Lund Kristensen, Søren

AU - Fosbøl, Emil L

AU - Emborg Vinding, Naja

AU - Lippert, Freddy

AU - Kragholm, Kristian

AU - Jøns, Christian

AU - Hansen, Steen M.

AU - Køber, Lars

AU - Karl Jacobsen, Peter

AU - Tfelt-Hansen, Jacob

AU - Weeke, Peter E

N1 - Copyright © 2022. Published by Elsevier B.V.

PY - 2022

Y1 - 2022

N2 - AIM: Treatment with certain drugs can augment the risk of developing malignant arrhythmias (e.g. torsades de pointes [TdP]). Hence, we examined the overall TdP risk drug use before out-of-hospital cardiac arrest (OHCA) and possible association with shockable rhythm and return of spontaneous circulation (ROSC).METHODS: Patients ≥18 years with an OHCA of cardiac origin from the Danish Cardiac Arrest Registry (2001-2014) and TdP risk drug use according to www.CredibleMeds.org were identified. Factors associated with TdP risk drug use and secondly how use may affect shockable rhythm and ROSC were determined by multivariable logistic regression.RESULTS: We identified 27481 patients with an OHCA of cardiac origin (median age: 72 years [interquartile range 62.0, 80.0 years]). A total of 37% were in treatment with TdP risk drugs 0-30 days before OHCA compared with 33% 61-90 days before OHCA (p<0.001). Most commonly used TdP risk drugs were citalopram (36.1%) and roxithromycin (10.7%). Patients in TdP risk drug treatment were older (75 vs. 70 years) and more comorbid compared with those not in treatment. Subsequently, TdP risk drug use was associated with less likelihood of the presenting rhythm being shockable (odds ratio [OR]=0.63, 95%confidence interval [CI]:0.58-0.69) and ROSC (OR=0.73, 95%CI:0.66-0.80).CONCLUSION: TdP risk drug use increased in the time leading up to OHCA and was associated with reduced likelihood of presenting with a shockable rhythm and ROSC in an all-comer OHCA setting. However, patients in TdP risk drug treatment were older and more comorbid than patients not in treatment.

AB - AIM: Treatment with certain drugs can augment the risk of developing malignant arrhythmias (e.g. torsades de pointes [TdP]). Hence, we examined the overall TdP risk drug use before out-of-hospital cardiac arrest (OHCA) and possible association with shockable rhythm and return of spontaneous circulation (ROSC).METHODS: Patients ≥18 years with an OHCA of cardiac origin from the Danish Cardiac Arrest Registry (2001-2014) and TdP risk drug use according to www.CredibleMeds.org were identified. Factors associated with TdP risk drug use and secondly how use may affect shockable rhythm and ROSC were determined by multivariable logistic regression.RESULTS: We identified 27481 patients with an OHCA of cardiac origin (median age: 72 years [interquartile range 62.0, 80.0 years]). A total of 37% were in treatment with TdP risk drugs 0-30 days before OHCA compared with 33% 61-90 days before OHCA (p<0.001). Most commonly used TdP risk drugs were citalopram (36.1%) and roxithromycin (10.7%). Patients in TdP risk drug treatment were older (75 vs. 70 years) and more comorbid compared with those not in treatment. Subsequently, TdP risk drug use was associated with less likelihood of the presenting rhythm being shockable (odds ratio [OR]=0.63, 95%confidence interval [CI]:0.58-0.69) and ROSC (OR=0.73, 95%CI:0.66-0.80).CONCLUSION: TdP risk drug use increased in the time leading up to OHCA and was associated with reduced likelihood of presenting with a shockable rhythm and ROSC in an all-comer OHCA setting. However, patients in TdP risk drug treatment were older and more comorbid than patients not in treatment.

U2 - 10.1016/j.resuscitation.2022.08.008

DO - 10.1016/j.resuscitation.2022.08.008

M3 - Journal article

C2 - 35964772

VL - 179

SP - 105

EP - 113

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -