Association of the duration of on-scene advanced life support with good neurological recovery in out-of-hospital cardiac arrest

2021 ◽  
Vol 50 ◽  
pp. 486-491
Author(s):  
Dong-Hyun Jang ◽  
You Hwan Jo ◽  
Seung Min Park ◽  
Kui Ja Lee ◽  
Yu Jin Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Neurological Recovery ◽  
Hospital Cardiac Arrest

scholarly journals External validation of multimodal termination of resuscitation rules for out-of-hospital cardiac arrest patients in the COVID-19 era

2020 ◽  
Author(s):  
Haewon Jung ◽  
Mijin Lee ◽  
Jae Wan Cho ◽  
Sang Hun Lee ◽  
Suk Hee Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Disease Transmission ◽  
Life Support ◽  
External Validation ◽  
Advanced Life Support ◽  
Survival Outcomes ◽  
Shock Delivery ◽  
Treatment Protocols ◽  
Multicenter Observational Study ◽  
Hospital Cardiac Arrest

Abstract Background: Futile resuscitation for out-of-hospital cardiac arrest (OHCA) patients in the coronavirus disease (COVID)-19 era can lead to risk of disease transmission and unnecessary transport. Various existing basic or advanced life support (BLS or ALS, respectively) rules for the termination of resuscitation (TOR) have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: This was a multicenter observational study using the WinCOVID-19 Daegu registry data collected during February 18–March 31, 2020. The subjects were patients who showed cardiac arrest of presumed cardiac etiology. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity, specificity, false positive value (FPV), and positive predictive value (PPV) of each TOR rule were evaluated. Results: In total, 170 of the 184 OHCA patients were eligible and evaluated. TOR was recommended for 122 patients based on the international basic life support termination of resuscitation (BLS-TOR) rule, which showed 85% specificity, 74% sensitivity, 0.8% FPV, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPV (upper limit of 95% confidence interval <5%), specificity (100%), and PPV (>99%) criteria, only the KoCARC TOR rule I, which included a combination of three factors including not being witnessed by emergency medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock delivery or return of spontaneous circulation, was found to be superior to all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARC TOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

Abstract 344: The Association Between ALS Response Interval and Out-of Hospital Cardiac Arrest Outcomes

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Brian Grunau ◽  
Takahisa Kawano ◽  
John Tallon ◽  
Frank Scheuermeyer ◽  
Joshua Reynolds ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Secondary Analysis ◽  
Advanced Life Support ◽  
Median Response ◽  
Neurological Outcomes ◽  
Spline Curves ◽  
Response Interval ◽  
Optimal Deployment ◽  
Hospital Cardiac Arrest

Objective: There is conflicting data in studies investigating the effectiveness of advanced life support (ALS) for out-of-hospital cardiac arrest (OHCA). Within a tiered BLS-ALS system, we sought to determine if the ALS response interval was associated with patient outcomes. Methods: This secondary analysis examined prospectively identified consecutive non-traumatic adult OHCAs from 2006-2016 in British Columbia. We excluded EMS-witnessed arrests and those not treated by ALS. The primary and secondary outcomes were survival and favorable neurological outcomes (mRS ≤3) at hospital discharge. Using logistic regression we estimated the association of ALS response interval (9-1-1 call to ALS arrival) and outcomes, adjusting for treatment year, response interval of the first EMS unit, and other baseline characteristics. We drew spline curves to illustrate this relationship. Results: Of 12,722 included cases, survival was 12%. The median response interval for the first EMS unit was 6.4 minutes (IQR 5.2 - 8.3) and for ALS was 11.8 minutes (IQR 8.7 - 16.5).The adjusted odds of survival and favourable neurological outcome for each additional minute in ALS response interval were 0.98 (95 % CI 0.96-0.99) and 0.98, (95% CI 0.97-0.99) respectively. The spline curve demonstrated an initial decline in survival probability that moderated at approximately 11 minutes. Conclusion: Among ALS-treated subjects within our tiered EMS system, earlier ALS arrival was associated with improved survival and favorable neurological outcomes. The greatest yield of ALS care may be prior to 11 minutes. This may help inform the optimal deployment configuration of prehospital providers.

scholarly journals Mean initial cerebral saturation and time to start advanced life support in out-of-hospital cardiac arrest: are they correlated?

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P490
Author(s):  
C Genbrugge ◽  
C De Deyne ◽  
I Meex ◽  
F Jans ◽  
W Boer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Cerebral Saturation ◽  
Hospital Cardiac Arrest

Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest

2019 ◽  
Vol 36 (8) ◽  
pp. 479-484 ◽  
Author(s):  
Mark H Ebell ◽  
Akke Vellinga ◽  
Siobhan Masterson ◽  
Phillip Yun
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Meta Analysis ◽  
Advanced Life Support ◽  
Study Quality ◽  
European Resuscitation Council ◽  
Comprehensive Search ◽  
Hospital Cardiac Arrest ◽  
Low Rate

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

scholarly journals The influence of advanced life support response time on patient outcomes after out-of-hospital cardiac arrest in Taipei

Resuscitation ◽  
2019 ◽  
Vol 142 ◽  
pp. e101
Author(s):  
Ying-Chih Ko ◽  
Jen-Tang Sun ◽  
Wen-Chu Chiang ◽  
Yu-Chun Chien ◽  
Yao-Cheng Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Patient Outcomes ◽  
Life Support ◽  
Advanced Life Support ◽  
Hospital Cardiac Arrest

scholarly journals Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S82-S89
Author(s):  
Michael Poppe ◽  
Mario Krammel ◽  
Christian Clodi ◽  
Christoph Schriefl ◽  
Alexandra-Maria Warenits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

Sign in / Sign up

Export Citation Format

Share Document