scholarly journals PERFORMANCE OF SOFA SCORE TO PREDICT MORTALITY AT HOSPITAL DISCHARGE AFTER CARDIAC ARREST

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A681
Author(s):  
Rahul Pawar ◽  
Parth Patel ◽  
Ari Moskowitz ◽  
Thomas Leith ◽  
Katherine Berg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Sofa Score

Abstract 353: Performance of SOFA Score to Predict Mortality at Hospital Discharge After Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Anne V Grossestreuer ◽  
Tuyen Yankama ◽  
Ari Moskowitz ◽  
Anthony Mahoney-Pacheco ◽  
Varun Konanki ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Sofa Score ◽  
Statistical Power ◽  
Goodness Of Fit ◽  
Outcome Measure ◽  
Model Performance ◽  
Surrogate Outcome ◽  
Surrogate Outcome Measure ◽  
Good Calibration

Introduction: Cardiac arrest (CA) outcomes, when dichotomized as survival/non-survival, limit statistical power of interventional studies and do not acknowledge hospital-level factors independent of post-CA sequelae. We explored the Sequential Organ Failure Assessment (SOFA) score at 72 hours post-CA as a surrogate outcome measure for mortality. We also assessed methods to account for death <72 hours post-CA in SOFA score computation. Methods: This was a single center retrospective study of post-CA patients from 1/08-12/17. SOFA score components were abstracted at baseline, 24, 48, and 72h post-CA. Thirteen ways of accounting for missing data were assessed. The outcome was mortality at hospital discharge. Model performance was assessed using area under the receiver-operator characteristic (AUC) curves and Hosmer-Lemeshow goodness of fit statistics. Results: Of 847 patients, 528 (62%) had complete baseline SOFA scores and 205 (24%) had complete scores at 72h. Death <72h occurred in 28%; 45% survived to hospital discharge. SOFA score at 72h without accounting for death had an AUC of 0.62. The best performing SOFA model at 72h with good calibration imputed a 20% increase over the last observed SOFA score in patients who expired <72h with an AUC of 0.79 (95% CI: 0.74-0.83). In terms of change in SOFA at 72h from baseline, the best performing model with good calibration imputed death <72h as the highest possible score (AUC: 0.88 [95% CI: 0.84-0.92]). These results were consistent when analyzing in- and out-of-hospital CA separately, although the change from baseline model was not well calibrated in in-hospital arrests. Conclusions: Without consideration of death, SOFA scores at 72 hours post-CA perform poorly. Imputing for early mortality improved the model. If this imputation structure is validated prospectively, SOFA could provide a scoring system to predict death at hospital discharge and serve as a surrogate outcome measure in interventional studies.

scholarly journals Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Yu-Lin Hsieh ◽  
Meng-Che Wu ◽  
Jon Wolfshohl ◽  
James d’Etienne ◽  
Chien-Hua Huang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Vascular Access ◽  
Subgroup Analysis ◽  
Observational Studies ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hospital Cardiac Arrest

Abstract Introduction This study is aimed to investigate the association of intraosseous (IO) versus intravenous (IV) route during cardiopulmonary resuscitation (CPR) with outcomes after out-of-hospital cardiac arrest (OHCA). Methods We systematically searched PubMed, Embase, Cochrane Library and Web of Science from the database inception through April 2020. Our search strings included designed keywords for two concepts, i.e. vascular access and cardiac arrest. There were no limitations implemented in the search strategy. We selected studies comparing IO versus IV access in neurological or survival outcomes after OHCA. Favourable neurological outcome at hospital discharge was pre-specified as the primary outcome. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I2 statistics. Time to intervention, defined as time interval from call for emergency medical services to establishing vascular access or administering medications, was hypothesized to be a potential outcome moderator and examined in subgroup analysis with meta-regression. Results Nine retrospective observational studies involving 111,746 adult OHCA patients were included. Most studies were rated as high quality according to Newcastle-Ottawa Scale. The pooled results demonstrated no significant association between types of vascular access and the primary outcome (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27–1.33; I2, 95%). In subgroup analysis, time to intervention was noted to be positively associated with the pooled OR of achieving the primary outcome (OR: 3.95, 95% CI, 1.42–11.02, p: 0.02). That is, when the studies not accounting for the variable of “time to intervention” in the statistical analysis were pooled together, the meta-analytic results between IO access and favourable outcomes would be biased toward inverse association. No obvious publication bias was detected by the funnel plot. Conclusions The meta-analysis revealed no significant association between types of vascular access and neurological outcomes at hospital discharge among OHCA patients. Time to intervention was identified to be an important outcome moderator in this meta-analysis of observation studies. These results call for the need for future clinical trials to investigate the unbiased effect of IO use on OHCA CPR.

Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest

Resuscitation ◽  
2021 ◽  
Vol 164 ◽  
pp. 30-37
Author(s):  
Richard Chocron ◽  
Carol Fahrenbruch ◽  
Lihua Yin ◽  
Sally Guan ◽  
Christopher Drucker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Functional Status ◽  
Hospital Discharge ◽  
Term Survival ◽  
Long Term Survival ◽  
Hospital Cardiac Arrest

scholarly journals Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1389
Author(s):  
Wojciech Wieczorek ◽  
Jarosław Meyer-Szary ◽  
Milosz J. Jaguszewski ◽  
Krzysztof J. Filipiak ◽  
Maciej Cyran ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
One Year

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.

scholarly journals 156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

2020 ◽  
Vol 37 (12) ◽  
pp. 825.1-825
Author(s):  
Ed Barnard ◽  
Daniel Sandbach ◽  
Tracy Nicholls ◽  
Alastair Wilson ◽  
Ari Ercole
Keyword(s):  
Overall Survival ◽  
Cardiac Arrest ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Discharge Data ◽  
Successful Resuscitation ◽  
Bystander Cpr ◽  
Number Percentage ◽  
Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

Abstract 365: Left Ventricular Wall Findings in Non-Electrocardiography-Gated Contrast-Enhanced Computed Tomography After Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Kazuhiro Sugiyama ◽  
Kazuki Miyazaki ◽  
Takuto Ishida ◽  
Takahiro Tanabe ◽  
Yuichi Hamabe
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Hospital Discharge ◽  
Left Ventricular ◽  
Left Ventricular Wall ◽  
Ventricular Wall ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Significant Stenosis ◽  
Contrast Enhanced

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory cardiac arrest. Computed tomography (CT) is often performed after ECPR for diagnosis of etiology and evaluation of complications. However, few studies have reported left ventricular wall findings in contrast-enhanced CT (CE-CT) after ECPR. This study examined the left ventricular wall CE-CT findings after ECPR, and evaluated the association between these findings and the results of coronary angiography and prognosis. Method: We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and then underwent both non-ECG gated CE-CT and coronary angiography at our center between January 2011 and April 2018. The left ventricular wall CE-CT findings at 90 s after contrast injection were classified as follows: homogeneously-enhanced (HE), left ventricular wall was homogeneously enhanced; segmental defect (SD), left ventricular wall was not segmentally enhanced according to coronary artery territory; total defect (TD), entire left ventricular wall was not enhanced; and others. Significant stenosis on coronary angiography, survival to hospital discharge, and successful weaning from extracorporeal membrane oxygenation (ECMO) were examined. Results: A total of 111 patients were eligible. Median age was 59 years, and 85 (77%) had initial shockable rhythm. A total of 37 (33%) survived to hospital discharge. HE was observed in 33 patients, SD in 41, TD in 15, and others in 22. Among 74 patients who underwent CT prior to coronary angiography, SD predicted significant stenosis, with sensitivity of 83% and specificity of 100%. Among all patients, 28 (85%) with HE, 15 (37%) with SD, and 3 (20%) with TD were weaned successfully from ECMO. In addition, 17 (52%) patients with HE, 10 (24%) with SD, and 2 (13%) with TD survived to hospital discharge. Conclusion: SD could predict coronary artery stenosis with good specificity. Patients with HE had higher success rates for weaning from ECMO. On the other hand, TD was associated with poor outcomes. The left ventricular wall findings in non-ECG gated CE-CT after ECPR might be useful in diagnosis and prognostication.

Abstract 12769: Amplitude-Spectral Area of the Ventricular Fibrillation Waveform and Chest Compression Quality in Witnessed and Unwitnessed Out-Of-Hospital Cardiac Arrest: Can We Predict Who is Unlikely to Survive?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julia Indik ◽  
Zacherie Conover ◽  
Meghan McGovern ◽  
Annemarie Silver ◽  
Daniel Spaite ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Chest Compression ◽  
Stepwise Logistic Regression ◽  
Individual Subject ◽  
Spectral Area ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Background: Previous investigations in human out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) have shown that the frequency-based waveform characteristic, amplitude spectral area (AMSA) predicts defibrillation success and is associated with survival to hospital discharge. We evaluated the relative strength of factors associated with hospital discharge including witnessed/unwitnessed status, chest compression (CC) quality and AMSA. We then investigated if there is a threshold value for AMSA that can identify patients who are unlikely to survive. Methods: Adult OHCA patients (age ≥18), with initial rhythm of VF from an Utstein-Style database (collected from 2 EMS systems) were analyzed. AMSA was measured from the waveform immediately prior to each shock, and averaged for each individual subject (AMSA-ave). Univariate and stepwise multivariable logistic regression, and receiver-operator-characteristic (ROC) analyses were performed. Factors analyzed: age, sex, witnessed status, time from dispatch to monitor/defibrillator application, number of shocks, mean CC rate, depth, and release velocity (RV). Results: 140 subjects were analyzed, [104 M (74%), age 62 ± 14 yrs, witnessed 65%]. Survival was 38% in witnessed and 16% in unwitnessed arrest. In univariate analyses, age (P=0.001), witnessed status (P=0.009), AMSA-ave (P<0.001), mean CC depth (P=0.025), and RV (P< 0.001) were associated with survival. Stepwise logistic regression identified AMSA-ave (P<0.001), RV (P=0.001) and age (P=0.018) as independently associated with survival. The area under the curve (ROC analysis) was 0.849. The probability of survival was < 5% in witnessed arrest for AMSA-ave < 5 mV-Hz, and in unwitnessed arrest for AMSA-ave < 15 mV-Hz. Conclusion: In OHCA with an initial rhythm of VF, AMSA-ave and CC RV are highly associated with survival. Further study is needed to evaluate whether AMSA-ave may be useful to identify patients highly unlikely to survive.

Abstract 17847: Gasping is a Valid Predictor Of ROSC and Hospital Discharge for In-hospital Cardiac Arrest Occurring on the Ward

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Luca Marengo ◽  
Wolfgang Ummenhofer ◽  
Gerster Pascal ◽  
Falko Harm ◽  
Marc Lüthy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Survival Data ◽  
Neurological Outcome ◽  
Rapid Response Team ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Data Set ◽  
Hospital Cardiac Arrest

Introduction: Agonal respiration has been shown to be commonly associated with witnessed events, ventricular fibrillation, and increased survival during out-of-hospital cardiac arrest. There is little information on incidence of gasping for in-hospital cardiac arrest (IHCA). Our “Rapid Response Team” (RRT) missions were monitored between December 2010 and March 2015, and the prevalence of gasping and survival data for IHCA were investigated. Methods: A standardized extended in-hospital Utstein data set of all RRT-interventions occurring at the University Hospital Basel, Switzerland, from December 13, 2010 until March 31, 2015 was consecutively collected and recorded in Microsoft Excel (Microsoft Corp., USA). Data were analyzed using IBM SPSS Statistics 22.0 (IBM Corp., USA), and are presented as descriptive statistics. Results: The RRT was activated for 636 patients, with 459 having a life-threatening status (72%; 33 missing). 270 patients (59%) suffered IHCA. Ventricular fibrillation or pulseless ventricular tachycardia occurred in 42 patients (16% of CA) and were associated with improved return of spontaneous circulation (ROSC) (36 (97%) vs. 143 (67%; p<0.001)), hospital discharge (25 (68%) vs. 48 (23%; p<0.001)), and discharge with good neurological outcome (Cerebral Performance Categories of 1 or 2 (CPC) (21 (55%) vs. 41 (19%; p<0.001)). Gasping was seen in 128 patients (57% of CA; 46 missing) and was associated with an overall improved ROSC (99 (78%) vs. 55 (59%; p=0.003)). In CAs occurring on the ward (154, 57% of all CAs), gasping was associated with a higher proportion of shockable rhythms (11 (16%) vs. 2 (3%; p=0.019)), improved ROSC (62 (90%) vs. 34 (55%; p<0.001)), and hospital discharge (21 (32%) vs. 7 (11%; p=0.006)). Gasping was not associated with neurological outcome. Conclusions: Gasping was frequently observed accompanying IHCA. The faster in-hospital patient access is probably the reason for the higher prevalence compared to the prehospital setting. For CA on the ward without continuous monitoring, gasping correlates with increased shockable rhythms, ROSC, and hospital discharge.

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