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Relationship between D-dimer level upon emergency room arrival and the duration of cardiac arrest in patients with witnessed out-of-hospital cardiac arrest

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Abstract

In patients with out-of-hospital cardiac arrest (OHCA), the probability of resuscitation is strongly influenced by the duration of cardiac arrest, which activates the blood coagulation–fibrinolysis system. Because plasma D-dimer levels reflect activity of blood coagulation and fibrinolysis, they should increase with the duration of cardiac arrest. We evaluated 222 consecutive non-traumatic witnessed OHCA patients who underwent measurement of plasma D-dimer levels on arrival in the emergency room. Return of spontaneous circulation was achieved in 138 patients (62%), but only 42 (19%) were alive 30 days post-OHCA. D-dimer levels were elevated in 217 patients (97.7%). There was a positive correlation between plasma D-dimer levels and duration of cardiac arrest in the 222 patients (r = 0.623, p < 0.001). When the cause of OHCA was limited to cardiovascular disease, the positive correlation between level of D-dimer and the duration of cardiac arrest (r = 0.776, p < 0.001) increased.

D-dimer levels were significantly lower in survivors than in non-survivors [9.5 (1.4–17.5) vs 54.2 (34.2–74.3) μg/mL, p = 0.024]. Receiver operating characteristic curve analysis showed that a cutoff value of D-dimer ≤ 10 μg/L led to sensitivity (69.0%) and specificity (72.8%) for 30 day survival (area under curve 0.75). Multivariate logistic regression analysis showed that D-dimer ≤ 10 μg/ml was an independent predictor for 30 day survival (odds ratio 4.39, 95% confidence interval 1.41–13.70; p = 0.01). D-dimer level correlates with duration of cardiac arrest, especially in OHCA patients due to cardiovascular causes, and may help physicians assess the probability of survival in OHCA patients.

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References

  1. Nichol G, Thomas E, Callaway CW, Hedges J, Powell JL, Aufderheide TP, Rea T, Lowe R, Brown T, Dreyer J, Davis D, Idris A, Stiell I (2008) Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 300:1423–1431

    Article  CAS  Google Scholar 

  2. Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, Ringh M, Jonsson M, Axelsson C, Lindqvist J, Karlsson T, Svensson L (2015) Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med 372:2307–2315

    Article  CAS  Google Scholar 

  3. Link MS, Atkins DL, Passman RS, Halperin HR, Samson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE (2010) Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122(Suppl 3):S706-719

    Article  Google Scholar 

  4. Böttiger BW, Motsch J, Böhrer H, Böker T, Aulmann M, Nawroth PP, Martin E (1995) Activation of blood coagulation after cardiac arrest is not balanced adequately by activation of endogenous fibrinolysis. Circulation 92:2572–2578

    Article  Google Scholar 

  5. Hostler D, Callaway CW, Newman DH, D’Cruz B (2007) Thrombin-antithrombin appearance in out-of-hospital cardiac arrest. Prehosp Emerg Care 11:9–13

    Article  Google Scholar 

  6. Adrie C, Monchi M, Laurent I, Um S, Yan SB, Thuong M, Cariou A, Charpentier J, Dhainaut JF (2005) Coagulopathy after successful cardiopulmonary resuscitation following cardiac arrest: implication of the protein C anticoagulant pathway. J Am Coll Cardiol 46:21–28

    Article  Google Scholar 

  7. Szymanski FM, Karpinski G, Filipiak KJ, Platek AE, Hrynkiewicz-Szymanska A, Kotkowski M, Opolski G (2013) Usefulness of the D-dimer concentration as a predictor of mortality in patients with out-of-hospital cardiac arrest. Am J Cardiol 112:467–471

    Article  CAS  Google Scholar 

  8. Funada A, Goto Y, Tada H, Shimojima M, Hayashi K, Kawashiri M, Yamagishi M (2018) Effects of prehospital epinephrine administration on neurologically intact survival in bystander-witnessed out-of-hospital cardiac arrest patients with non-shockable rhythm depend on prehospital cardiopulmonary resuscitation duration required to hospital arrival. Heart Vessels 33:1525–1533

    Article  Google Scholar 

  9. Sugizaki Y, Shinke T, Doi T, Igarashi N, Otake H, Kawamori H, Hirata K (2019) Impact of the angiographic burden on the incidence of out-of-hospital ventricular fibrillation in patients with acute myocardial infarction. Heart Vessels 34:52–61

    Article  Google Scholar 

  10. Goto Y, Maeda T, Goto Y (2013) Decision-tree model for predicting outcomes after out-of-hospital cardiac arrest in the emergency department. Crit Care 17:R133

    Article  Google Scholar 

  11. Sasson C, Rogers MAM, Dahl J, Kellermann AL (2010) Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 3:63–81

    Article  Google Scholar 

  12. Lowe G, Rumley A (2014) The relevance of coagulation in cardiovascular disease: what do the biomarkers tell us? Thromb Haemost 112:860–867

    Article  Google Scholar 

  13. Wakai A, Gleeson A, Winter D (2003) Role of fibrin D-dimer testing in emergency medicine. Emerg Med J 20:319–325

    Article  CAS  Google Scholar 

  14. Ono Y, Hayakawa M, Maekawa K, Kodate A, Sadamoto Y, Tominaga N, Murakami H, Yoshida T, Katabami K, Wada T, Sageshima H, Sawamura A, Gando S (2017) Fibrin/fibrinogen degradation products (FDP) at hospital admission predict neurological outcomes in out-of-hospital cardiac arrest patients. Resuscitation 111:62–67

    Article  Google Scholar 

  15. Travers AH, Rea TD, Bobrow BJ, Edelson DP, Berg RA, Sayre MR, Berg MD, Chameides L, O’Connor RE, Swor RA (2010) Part 4: CPR overview: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122(Suppl 3):S676-684

    Article  Google Scholar 

  16. Tokita Y, Kusama Y, Kodani E, Tadera T, Nakagomi A, Atarashi H, Mizuno K (2009) Utility of rapid D-dimer measurement for screening of acute cardiovascular disease in the emergency setting. J Cardiol 53:334–340

    Article  Google Scholar 

  17. Conzelmann LO, Weigang E, Mehlhorn U, Abugameh A, Hoffmann I, Blettner M, Etz CD, Czerny M, Vahl CF, Investigators GERAADA (2016) Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German registry for acute aortic dissection type A (GERAADA). Eur J Cardiothorac Surg 49:e44-52

    Article  Google Scholar 

  18. Yusuff HO, Zochios V, Vuylsteke A (2015) Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a systematic review. Perfusion 30:611–616

    Article  CAS  Google Scholar 

  19. Schutte T, Thijs A, Smulders YM (2016) Never ignore extremely elevated D-dimer levels: they are specific for serious illness. Neth J Med 74:443–448

    CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Dr. Keiichi Yagi for assistance with patient records.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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  1. Mitsutoshi Asano and Manabu Kurabayashi contributed equally to this work.

Authors and Affiliations

  1. Division of Cardiology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shin-Yamashita, Naka-ward, Yokohama, 231-8682, Japan

    Mitsutoshi Asano, Manabu Kurabayashi & Yasuteru Yamauchi

  2. Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan

    Mitsutoshi Asano & Tetsuo Sasano

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  1. Mitsutoshi Asano
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  2. Manabu Kurabayashi
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  3. Yasuteru Yamauchi
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  4. Tetsuo Sasano
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Correspondence to Manabu Kurabayashi.

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Asano, M., Kurabayashi, M., Yamauchi, Y. et al. Relationship between D-dimer level upon emergency room arrival and the duration of cardiac arrest in patients with witnessed out-of-hospital cardiac arrest. Heart Vessels 36, 731–737 (2021). https://doi.org/10.1007/s00380-020-01745-3

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