Association of Suspected Aspiration During of Out‐Of‐Hospital Cardiac Arrest With Development of Early‐Onset Pneumonia

Background Early‐onset pneumonia is a possible complication after out‐of‐hospital cardiac arrest (OHCA) resuscitation. Whether or not a suspected aspiration during prehospital care is associated with the development of early‐onset pneumonia has not been studied. Methods We conducted a single‐centre prospective observational study among comatose out‐of‐hospital cardiac arrest survivors treated in the intensive care unit (ICU). Both prehospital emergency physicians and nurse‐paramedics completed a structured survey on possible aspiration after each successful resuscitation. The primary outcome was being diagnosed with early‐onset pneumonia within the first 96 h of ICU stay. Results A total of 55 patients were included, and 11 patients were suspected of having aspirated during their out‐of‐hospital cardiac arrest. Patients with suspected aspiration were younger, had a lower Charlson comorbidity index, and their out‐of‐hospital cardiac arrest was more often due to non‐cardiac aetiology with a non‐shockable primary rhythm. Patients with suspected aspiration had comparable oxygenation, ventilation, and ventilator parameters to the patients without suspected aspiration. Pneumonia findings on chest X‐rays, CT imaging, and infection parameters were similar across the patient groups. Early‐onset pneumonia during the first 96 h was as common in both groups (91% vs. 68%, p = 0.130). Prehospital suspicion of aspiration was not associated with early‐onset pneumonia in multivariable regression analysis (odds ratio 2.8, 95% confidence interval 0.29–28). Conclusion Suspicion of aspiration during out‐of‐hospital cardiac arrest was not associated with early‐onset pneumonia. However, this study was possibly underpowered to detect clinically relevant differences. Editorial Comment This study presents associations between post‐cardiac arrest and resuscitation early pneumonia and suspicion of pulmonary aspiration at the time of the out of hospital cardiac arrest and first treatment. In this cohort, there did not seem to be a clear association.