The Effect of Successful Intubation on Patient Outcomes After Out-of-Hospital Cardiac Arrest in Taipei

Introduction: It is unclear whether prehospital advanced airway management (AAM: endotracheal intubation and supraglottic airway device placement) for pediatric patients with out-of-hospital cardiac arrest (OHCA) improves patient outcomes. Objective: To test the hypothesis that prehospital advanced airway management during pediatric OHCA is associated with patient outcomes. Methods: We conducted a secondary analysis of a nationwide, prospective, population-based OHCA registry in Japan. We included pediatric patients (<18 years) with OHCA in whom emergency medical services (EMS) personnel resuscitated and transported to medical institutions during 2014 and 2015. The primary outcome was one-month survival. Secondary outcome was one-month survival with favorable functional outcome, defined as cerebral performance category score 1 or 2. Patients who received AAM during cardiopulmonary resuscitation by EMS personnel at any given minute were sequentially matched with patients at risk of receiving AAM within the same minutes based on time-dependent propensity score calculated from a competing risk regression model in which we treated prehospital return of spontaneous circulation as a competing risk event. Results: We included 2,548 patients; 1,017 (39.9%) were infants (<1 year), 839 (32.9%) were children (1 year to 12 years), and 692 (27.2%) were adolescents. Of the 2,548, included patients, 336 (13.2%) underwent prehospital AAM during cardiac arrest. In the time-dependent propensity score matched cohort (n = 642), there were no significant differences in one-month survival (AAM: 32/321 [10.0%] vs. no AAM: 27/321 [8.4%]; odds ratio, 1.33 [95% CI, 0.80 to 2.21]) and one-month survival with favorable functional outcome (AAM: 6/321 [1.9%] vs. no AAM: 5/321 [1.6%]; odds ratio, 1.48 [95% CI, 0.41 to 5.40]). Conclusions: Among pediatric patients with OHCA, we found no associations between prehospital AAM and favorable patient outcomes.

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Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest

AACN Advanced Critical Care ◽

10.4037/aacnacc2020297 ◽

2020 ◽

Vol 31 (4) ◽

pp. 401-409

Author(s):

Roberta Kaplow ◽

Pam Cosper ◽

Ray Snider ◽

Martha Boudreau ◽

John D. Kim ◽

...

Keyword(s):

Cardiac Arrest ◽

Patient Outcomes ◽

Life Support ◽

Patient Survival ◽

Average Rate ◽

Cardiopulmonary Arrest ◽

Academic Medical Center ◽

Convenience Sample ◽

Resuscitation Guidelines ◽

Hospital Cardiac Arrest

Background Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. Objectives To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. Methods An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. Results Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. Conclusions These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.

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

Resuscitation ◽

10.1016/j.resuscitation.2019.06.244 ◽

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

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Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2018.02.021 ◽

2018 ◽

Vol 126 ◽

pp. 72-79 ◽

Cited By ~ 10

Author(s):

Lars W. Andersen ◽

Mathias J. Holmberg ◽

Asger Granfeldt ◽

Bo Løfgren ◽

Kimberly Vellano ◽

...

Keyword(s):

Cardiac Arrest ◽

Patient Outcomes ◽

Automated External Defibrillator ◽

Neighborhood Characteristics ◽

Hospital Cardiac Arrest ◽

External Defibrillator

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Use of a simulation-based advanced resuscitation training curriculum: Impact on cardiopulmonary resuscitation quality and patient outcomes

Journal of the Intensive Care Society ◽

10.1177/1751143719838209 ◽

2019 ◽

Vol 21 (1) ◽

pp. 57-63 ◽

Cited By ~ 1

Author(s):

Amanda K Young ◽

Michael J Maniaci ◽

Leslie V Simon ◽

Philip E Lowman ◽

Ryan T McKenna ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Patient Outcomes ◽

Spontaneous Circulation ◽

Good Neurological Outcome ◽

Odds Ratios ◽

Rates Of Return ◽

Return Of Spontaneous Circulation ◽

Resuscitation Training ◽

Hospital Cardiac Arrest

Background Despite a continued focus on improved cardiopulmonary resuscitation quality, survival remains low from in-hospital cardiac arrest. Advanced Resuscitation Training has been shown to improve survival to hospital discharge and survival with good neurological outcome following in-hospital cardiac arrest at its home institution. We sought to determine if Advanced Resuscitation Training implementation would improve patient outcomes and cardiopulmonary resuscitation quality at our institution. Methods This was a prospective, before–after study of adult in-hospital cardiac arrest victims who had cardiopulmonary resuscitation performed. During phase 1, standard institution cardiopulmonary resuscitation training was provided. During phase 2, providers received the same quantity of training, but with emphasis on Advanced Resuscitation Training principles. Primary outcomes were return of spontaneous circulation, survival to hospital discharge, and neurologically favorable survival. Secondary outcomes were cardiopulmonary resuscitation quality parameters. Results A total of 156 adult in-hospital cardiac arrests occurred during the study period. Rates of return of spontaneous circulation improved from 58.1 to 86.3% with an adjusted odds ratios of 5.31 (95% CI: 2.23–14.35, P < 0.001). Survival to discharge increased from 26.7 to 41.2%, adjusted odds ratios 2.17 (95% CI: 1.02–4.67, P < 0.05). Survival with a good neurological outcome increased from 24.8 to 35.3%, but was not statistically significant. Target chest compression rate increased from 30.4% of patients in P1 to 65.6% in P2, adjusted odds ratios 4.27 (95% CI: 1.72–11.12, P = 0.002), and target depth increased from 23.2% in P1 to 46.9% in P2, adjusted odds ratios 2.92 (95% CI: 1.16–7.54, P = 0.024). Conclusions After Advanced Resuscitation Training implementation, there were significant improvements in cardiopulmonary resuscitation quality and rates of return of spontaneous circulation and survival to discharge.

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Towards the Prediction of Rearrest during Out-of-Hospital Cardiac Arrest

Entropy ◽

10.3390/e22070758 ◽

2020 ◽

Vol 22 (7) ◽

pp. 758

Author(s):

Andoni Elola ◽

Elisabete Aramendi ◽

Enrique Rueda ◽

Unai Irusta ◽

Henry Wang ◽

...

Keyword(s):

Machine Learning ◽

Cardiac Arrest ◽

Patient Outcomes ◽

Learning Model ◽

Spontaneous Circulation ◽

Operating Characteristics ◽

Machine Learning Model ◽

Validation Procedure ◽

Electrocardiogram Ecg ◽

Hospital Cardiac Arrest

A secondary arrest is frequent in patients that recover spontaneous circulation after an out-of-hospital cardiac arrest (OHCA). Rearrest events are associated to worse patient outcomes, but little is known on the heart dynamics that lead to rearrest. The prediction of rearrest could help improve OHCA patient outcomes. The aim of this study was to develop a machine learning model to predict rearrest. A random forest classifier based on 21 heart rate variability (HRV) and electrocardiogram (ECG) features was designed. An analysis interval of 2 min after recovery of spontaneous circulation was used to compute the features. The model was trained and tested using a repeated cross-validation procedure, on a cohort of 162 OHCA patients (55 with rearrest). The median (interquartile range) sensitivity (rearrest) and specificity (no-rearrest) of the model were 67.3% (9.1%) and 67.3% (10.3%), respectively, with median areas under the receiver operating characteristics and the precision–recall curves of 0.69 and 0.53, respectively. This is the first machine learning model to predict rearrest, and would provide clinically valuable information to the clinician in an automated way.

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The effect of the number and level of emergency medical technicians on patient outcomes following out of hospital cardiac arrest in Taipei

Resuscitation ◽

10.1016/j.resuscitation.2017.11.048 ◽

2018 ◽

Vol 122 ◽

pp. 48-53 ◽

Cited By ~ 11

Author(s):

Jen-Tang Sun ◽

Wen-Chu Chiang ◽

Ming-Ju Hsieh ◽

Edward Pei-Chuan Huang ◽

Wen-Shuo Yang ◽

...

Keyword(s):

Cardiac Arrest ◽

Patient Outcomes ◽

Emergency Medical Technicians ◽

Emergency Medical ◽

Hospital Cardiac Arrest

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Teamwork and leadership in out-of-hospital cardiac arrest – do these non-technical skills require attention?

Australasian Journal of Paramedicine ◽

10.33151/ajp.17.748 ◽

2020 ◽

Vol 17 ◽

Author(s):

Adam John Dagnell

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Patient Outcomes ◽

Patient Survival ◽

Training Programs ◽

Technical Skills ◽

Vital Role ◽

Cpr Quality ◽

Hospital Cardiac Arrest ◽

And Training

The science of cardiopulmonary resuscitation (CPR) is now well established and incorporated into training programs to maximise patient survival. There is an increased understanding that non-technical skills such as teamwork and leadership can play a vital role in improving CPR quality, patient outcomes and clinician occupational health. Despite this, these non-technical skills remain somewhat neglected in the context of out-of-hospital cardiac arrest. With reference to the literature this commentary provides a discussion to reinforce the need for a greater focus to this area of practice and build a case for further research and training.

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Abstract 290: The Association of Regional Intra-arrest Transport Practices for Out-of-hospital Cardiac Arrest with Survival and Neurological Status at Hospital Discharge

Circulation ◽

10.1161/circ.142.suppl_4.290 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Brian E Grunau ◽

Takahisa Kawano ◽

Masashi Okubo ◽

Joshua Reynolds ◽

Matthieu Heidet ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Patient Outcomes ◽

Patient Survival ◽

Secondary Analysis ◽

Neurological Status ◽

Spontaneous Circulation ◽

Regional Level ◽

Regional Clusters ◽

Hospital Cardiac Arrest

Background: There is substantial regional variation in out-of-hospital cardiac arrest (OHCA) outcomes. We investigated whether regional-level intra-arrest transport practices were associated with patient outcomes. Methods: We performed a secondary analysis of the “CCC Trial” dataset, which included EMS-treated adult non-traumatic OHCA enrolled from 49 regional clusters. The exposure of interest was regional-level intra-arrest transport practices (RIATP), calculated as the proportion of cases within the enrolling cluster transported prior to return of spontaneous circulation (“intra-arrest transport”), divided into quartiles. We fit a multilevel mixed-effects logistic regression model to estimate the association of RIATP quartile and both survival and favorable neurologic status (mRS ≤ 3) at hospital discharge, adjusted for patient-level Utstein variables. Results: We included all 26,148 CCC-enrolled patients, 36% of whom were female, 97% were treated with prehospital ALS, and 23% had shockable initial rhythms. The median RIATP of the 49 clusters was 20% (IQR 6.2 - 30%). The figure shows outcomes stratified by RIATP quartile. Compared to the first quartile (<6.2%), increasing RIATP had the following adjusted associations with: (i) favourable neurological status: OR 0.87 (95% CI 0.60-1.26), 0.74 (95% CI 0.51-1.07), 0.36 (95% CI 0.25-0.53); and (ii) survival: 0.63 (95% CI 0.47-0.85), 0.60 (95% CI 0.45-0.79), 0.44 (95% CI 0.33-0.59). Conclusion: Treatment within a region that utilizes intra-arrest transport less frequently was associated with improved patient survival. These results may, in part, explain differences between regional OHCA survival outcomes.

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