Abstract
BACKGROUND: Survivors of out-of-hospital cardiac arrest (OHCA) remain at significant risk of recurrence; however, the factors associated with a subsequent OHCA episode requiring hospitalisation are not well characterised. Dependence on indwelling devices may indicate a state of chronic vulnerability. This study aimed to identify risk factors for recurrent OHCA using a nationwide cohort. METHODS: We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database from 2010 to 2020. Adult non-traumatic OHCA survivors discharged alive were included and followed for up to five years. Demographics, comorbidities, healthcare utilisation, and long-term indwelling device use (nasogastric tube, Foley catheter, tracheostomy with ventilator) were analysed. The primary outcome was a second OHCA requiring hospitalisation. Multivariable logistic regression identified independent risk factors, with adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) reported. RESULTS: Among 15,617 OHCA survivors, 1,123 (7.2 %) experienced a second OHCA requiring hospitalisation within five years. Patients with recurrence were older (62.6 vs. 61.0 years, p < 0.001), and more frequently used indwelling devices. In multivariable analysis, nasogastric tube (aOR 1.82, 95 % CI 1.50-2.19, p < 0.001), Foley catheter (aOR 1.20, 95 % CI 1.00-1.43, p = 0.05), and tracheostomy with ventilator (aOR 0.85, 95 % CI 0.73-1.00, p = 0.043) were independently associated with recurrent OHCA, while age, sex, and pre-arrest diseases were not. CONCLUSION: Functional dependence and healthcare utilisation were associated with recurrent OHCA among survivors hospitalised for a recurrent event. Device dependence may serve as a marker of vulnerability, highlighting the need for ongoing monitoring and follow-up.