The role of brain tomography scan in patients with out-of-hospital cardiac arrest in whom return of spontaneous circulation

Background: Previous studies have shown that comatose survivors of cardiac arrest awaken approximately 3 days after return of spontaneous circulation (ROSC) however, variability in time to awakening is frequently observed. Recent data has shown that women metabolize drugs (sedatives and paralytics) differently than men. It is unknown if there are sex based differences in time to awakening for comatose survivors of cardiac arrest, and if this phenomenon might be affected by differences in withdrawal of life sustaining therapy (WLST). Objective: To determine if comatose women have different times to awakening after resuscitation from cardiac arrest. Methods: We analyzed 327 consecutive charts from a single center registry of all out of hospital cardiac arrest patients who had return of spontaneous circulation but remained comatose, cared for at an urban academic tertiary care hospital. Patient demographic and arrest characteristics were abstracted. We identified day of awakening for comatose survivors by abstracting day when Glasgow coma motor score was 6 as documented in nursing flowsheets. Time to withdrawal of life sustaining therapy was also abstracted for the cohort that did not awaken. Patients were excluded from analysis if they did not awaken or if they died for reasons other than WLST. Results: Twenty-eight percent of patients woke prior to hospital discharge and 43.4% underwent withdrawal of life sustaining therapy. Women made up 39.5% of the total cohort, 40% of the awakened cohort and 41% of the WLST cohort. Women had earlier day of awakening in comparison to men (day 2 (2, 4) vs. day 4 (2,5), p=0.0036), and also earlier time to WLST after ROSC than men (59 hours (26, 131) vs. 64 hours (22, 135), p=NS). Conclusion: In this single center cohort, there was a difference in time to awakening between men and women. How time to awakening might differ between the sexes with guideline concordant time to WLST is unknown. Further research is necessary to explore the role of therapeutic interventions and differing physiology between men and women as it applies to time to awakening.

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A Study Evaluating The Role Of Automated Cardiopulmonary Resuscitation In Achieving Return Of Spontaneous Circulation, Optimal Cerebral Perfusion And Neurological Outcomes In In-Hospital Cardiac Arrest

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a3153 ◽

2012 ◽

Author(s):

Asad A. Nasir ◽

Paul Richman ◽

Sam Parnia

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Perfusion ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Neurological Outcomes ◽

Hospital Cardiac Arrest

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Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2021.03.028 ◽

2021 ◽

Vol 60 (4) ◽

pp. 580-581

Author(s):

Vivian Diep ◽

Nhan “Marc” Phan

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

PLoS ONE ◽

10.1371/journal.pone.0175257 ◽

2017 ◽

Vol 12 (4) ◽

pp. e0175257 ◽

Cited By ~ 4

Author(s):

Hiroyuki Koami ◽

Yuichiro Sakamoto ◽

Ryota Sakurai ◽

Miho Ohta ◽

Hisashi Imahase ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Arrest ◽

Spontaneous Circulation ◽

Adult Patients ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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The association between end-tidal CO2 and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity

Resuscitation ◽

10.1016/j.resuscitation.2021.08.014 ◽

2021 ◽

Vol 167 ◽

pp. 76-81

Author(s):

Michael Crickmer ◽

Ian R. Drennan ◽

Linda Turner ◽

Sheldon Cheskes

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

End Tidal ◽

Hospital Cardiac Arrest ◽

End Tidal Co2

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Development and validation of early prediction for neurological outcome at 90 days after return of spontaneous circulation in out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2021.09.027 ◽

2021 ◽

Vol 168 ◽

pp. 142-150

Author(s):

Norihiro Nishioka ◽

Daisuke Kobayashi ◽

Takeyuki Kiguchi ◽

Taro Irisawa ◽

Tomoki Yamada ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

Early Prediction ◽

Return Of Spontaneous Circulation ◽

Development And Validation ◽

Hospital Cardiac Arrest

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Abstract P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year

Circulation ◽

10.1161/circ.118.suppl_18.s_1463 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jocelyn Berdowski ◽

Andra Schmohl ◽

Rudolph W Koster

Keyword(s):

Cardiac Arrest ◽

World Wide ◽

Prospective Observational Study ◽

Spontaneous Circulation ◽

Chest Compressions ◽

Return Of Spontaneous Circulation ◽

Resuscitation Guidelines ◽

Rhythm Analysis ◽

New Guidelines ◽

Hospital Cardiac Arrest

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines. Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005). Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1 ). Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.

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Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽

10.1161/circ.130.suppl_2.13131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shuichi Hagiwara ◽

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Kei Hayashida ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Statistical Significance ◽

Coronary Arteriography ◽

Spontaneous Circulation ◽

P Value ◽

Return Of Spontaneous Circulation ◽

Overall Performance ◽

The Mean ◽

Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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