Factors associated with prolonged cardiopulmonary resuscitation attempts in out-of-hospital cardiac arrest patients presenting to the emergency department

2020 ◽  
Author(s):  
Hashim Embong ◽  
Syakirah Anisa Md Isa ◽  
Husyairi Harunarashid ◽  
Azlan Helmy Abd Samat
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Factors Associated ◽  
Hospital Cardiac Arrest

scholarly journals Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study

2019 ◽  
Vol 41 (21) ◽  
pp. 1961-1971 ◽  
Author(s):  
Wulfran Bougouin ◽  
Florence Dumas ◽  
Lionel Lamhaut ◽  
Eloi Marijon ◽  
Pierre Carli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Conditional Logistic Regression ◽  
Time Duration ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Factors Associated ◽  
Hospital Survival ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest ◽  
Extracorporeal Cpr

Abstract Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002). Conclusions In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

scholarly journals Implementation of Targeted Temperature Management After Out‐of‐Hospital Cardiac Arrest: Observations From the Los Angeles County Regional System

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Melody Hermel ◽  
Nichole Bosson ◽  
Andrea Fang ◽  
William J. French ◽  
James T. Niemann ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Los Angeles ◽  
Los Angeles County ◽  
The United States ◽  
System Of Care ◽  
Temperature Management ◽  
Factors Associated ◽  
Regional System ◽  
Hospital Cardiac Arrest

Background Despite the benefits of targeted temperature management (TTM) for out‐of‐hospital cardiac arrest), implementation within the United States remains low. The objective of this study was to evaluate the prevalence and factors associated with TTM use in a large, urban‐suburban regional system of care. Methods and Results This was a retrospective analysis from the Los Angeles County regional cardiac system of care serving a population of >10 million residents. All adult patients aged ≥18 years with non‐traumatic out‐of‐hospital cardiac arrest transported to a cardiac arrest center from April 2011 to August 2017 were included. Patients awake and alert in the emergency department and patients who died in the emergency department before consideration for TTM were excluded. The primary outcome measure was prevalence of TTM use. The secondary analysis were annual trends in TTM use over the study period and factors associated with TTM use. The study population included 8072 patients; 4154 patients (51.5%) received TTM and 3767 patients (46.7%) did not receive TTM. Median age was 67 years, 4780 patients (59.2%) were men, 4645 patients (57.5%) were non‐White, and the most common arrest location was personal residence in 4841 patients (60.0%). In the adjusted analysis, younger age, male sex, an initial shockable rhythm, witnessed arrest, and receiving coronary angiography were associated with receiving TTM. Conclusions Within this regional system of care, use of TTM was higher than previously reported in the literature at just over 50%. Use of integrated systems of care may be a novel method to increase TTM use within the United States.

Abstract 171: Developing an ECPR Program for Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Meshe Chonde ◽  
Jeremiah Escajeda ◽  
Jonathan Elmer ◽  
Arthur Boujoukos ◽  
Penny L Sappington ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Coronary Intervention ◽  
Quality Improvement Initiative ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Catheterization Laboratory ◽  
Program Selection ◽  
Alternative Means ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a novel treatment for cardiac arrest that is refractory to conventional cardiopulmonary resuscitation (CPR). As part of a quality improvement initiative we sought to develop a program at our institution. Hypothesis: ECPR is a feasible and effective alternative means of resuscitation for patients in refractory cardiac arrest. Methods: We developed a multidisciplinary ECPR team consisting of staff from Emergency Medical Services (EMS), Emergency Department, Cardiology, Cardiac Surgery and Critical Care Medicine. Patients with an out of hospital cardiac arrest (OHCA) refractory to medical treatment were identified by EMS and brought to our institution if they met our program selection criteria. The patient was cannulated in the Emergency Department or Catheterization Laboratory, then underwent coronary angiogram with intervention if applicable and was transferred to cardiothoracic intensive care unit (ICU) for further care. Results: From October 1 st 2015 to March 31 st 2018, a total of 1165 out of hospital cardiac arrests occurred, of which five met criteria for our study. Median age was 47 [IQR 32-53] and four were men. Most common arrest rhythm was VF (80%), one patient had ST elevation on EKG. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min with 5 [IQR 3-6] defibrillations and 6 [IQR 6-7] doses of epinephrine administered. Four patients were successfully cannulated (80%). Cannulation time was 21 [IQR 16-33] min, with one patient achieving ROSC during cannulation. All patients underwent angiography, with two patients receiving coronary intervention (40%). ECMO duration was 48 [IQR 38-68] hours and length of stay was 2 [IQR 2-8] days. All patients had an initial Pittsburgh Cardiac Arrest Category of 4. Two patients (40%) survived to hospital discharge with good neurologic function. Conclusions: ECPR is a potentially life-saving alternative treatment to conventional CPR that is feasible in our patient population.

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: A Danish nationwide multicentre study

2021 ◽  
Author(s):  
Sivagowry Rasalingam Mørk ◽  
Carsten Stengaard ◽  
Louise Linde ◽  
Jacob Eifer Møller ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Good Neurological Outcome ◽  
Strict Adherence ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to to describe the gradual implementation, survival and adherence to the national consensus with respect to use of ECPR for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving ECPR for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan-Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day survival. Results A total of 259 patients were included in the study. Thirty-day survival was 26% and a good neurological outcome (Glasgow-Pittsburgh Cerebral Performance Categories (CPC) (CPC 1–2)) was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 minutes, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had a threefold higher survival rate compared to patients without signs of life (45% versus 13%, p < 0.001). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with ECPR for OHCA. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary.

scholarly journals Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S R Moerk ◽  
C Stengaard ◽  
L Linde ◽  
J E Moller ◽  
J B Andreasen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Good Neurological Outcome ◽  
Strict Adherence ◽  
Factors Associated ◽  
National Consensus ◽  
Hospital Cardiac Arrest

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking. Purpose To describe the survival, neurological outcome, and adherence to the national consensus with respect to use of ECPR for OHCA, and to identify factors associated with outcome. Methods Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality. Results A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow &lt;100 minutes, pH &gt;6.8 and lactate &lt;15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH &lt;6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels &gt;15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of life (45% versus 13%, p&lt;0.001) Conclusion A high survival rate with a good neurological outcome was observed in this population of patients treated with ECPR for OHCA. Signs of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported by the Danish Heart Foundation [20-R142-A9498-22178]; and Health Research Foundation of Central Denmark Region [R64-A3178-B1349] Survival and adherence to consensus Signs of life during CPR

Sign in / Sign up

Export Citation Format

Share Document