scholarly journals IN-HOSPITAL CARDIAC ARREST OUTCOMES IN ADULT PATIENT WITH INHERITED THROMBOPHILIA: A STUDY OF THE US NATIONAL INPATIENT SAMPLE

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1116
Author(s):  
Tien-Chan Hsieh ◽  
Guangchen Zou ◽  
Pramuditha Rajapakse ◽  
Gin Yi Lee
Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Lars W Andersen ◽  
Mathias J Holmberg ◽  
Asger Granfeldt ◽  
Lyndon P James ◽  
Lisa Caulley

Introduction: Despite a consistent association with improved outcomes, automated external defibrillators (AEDs) are used in only approximately 10% of public out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost. The objective of this study was to provide a contemporary cost-effectiveness analysis on the use of public AEDs in the United States (US) to inform guidelines and public health initiatives. Methods: We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the US over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs (in 2017 US dollars) per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. It was assumed that AED use was associated with a 52% relative increase in survival to hospital discharge with a favorable neurological outcome in those with a shockable rhythm. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. Consistent with recent guidelines from the American Heart Association, we used a willingness-to-pay threshold of $150,000 per QALY gained. Results: The no AED strategy resulted in 1.63 QALYs at a cost of $42,757. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. At an incidence of 1%, the incremental cost-effectiveness ratio was $101,040 per QALY gained. In sensitivity analyses across a plausible range of health-care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. Conclusion: Public AEDs are a cost-effective public health intervention in the US. These findings support widespread dissemination of public AEDs.


Author(s):  
Arnoley S. Abcejo ◽  
Jeffrey J. Pasternak

Cardiac arrest occurs suddenly, often without premonitory symptoms. Consciousness is lost within seconds to minutes because of insufficient cerebral blood flow in the midst of complete hemodynamic collapse. Anoxic-ischemic brain injury is most commonly caused by cardiac arrest, which is frequently lethal; of the US patients with out-of-hospital cardiac arrest treated by emergency medical services, almost 90% die. Among the patients who survive to hospital admission, inpatient mortality may be decreasing, but a substantial number of those survivors have poor neurologic outcomes from anoxic-ischemic brain injury.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jonathan Gelber ◽  
Martha E Montgomery ◽  
Amandeep Singh

Introduction: Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence. A single Japanese prospective study found a high incidence of ICH in survivors of OHCA (18.3% incidence), but that data is not generalizable to the US, which has a far lower overall rate of ICH. Aim: This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC). Methods: We prospectively analyzed all consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period from 2018-2020. A standardized order set, including non-contrast head computed-tomography (NCH-CT), was recommended as part of the initial management for all patients with ROSC after OHCA. Patient and cardiac arrest variables were recorded, as were NCH-CT findings. Results: During the study period, 194 patients presents to the emergency department with OHCA, and 95 patients achieved ROSC and survived to hospital admission. A NCH-CT was obtained in 85/95 patients (89.5%). Twenty-four of 85 patients (28.2%) survived to hospital discharge. Three of 85 patients with NCH-CT had ICH (3.5%). Survival with good neurologic outcome was seen in 14/82 (17.1%) patients without ICH and in 0/3 patients with ICH. Patients with ICH were significantly older than patients without ICH (86.7 years versus 64.4 years, p=0.01). Conclusions: In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission. The incidence of ICH in survivors of OHCA was 3.5%, lower than previously reported retrospective data in the US, and much lower than reported in a prospective Japanese study. No patients with ICH survived with good neurologic outcome.


2017 ◽  
Vol 85 (5) ◽  
pp. AB176
Author(s):  
Vaibhav Wadhwa ◽  
Abhik Bhattacharya ◽  
Nitin Aggarwal ◽  
John J. Vargo ◽  
Gautam N. Mankaney

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Lin Guo ◽  
Pamela Owens ◽  
Marshal Isaacs ◽  
Tami Kayea ◽  
Lu Ann McKee ◽  
...  

Introduction: Since March, the CDC has reported weekly excess deaths of up to 40% in the US. Spikes in excess deaths were associated with spikes in COVID-19 cases. In Texas, 55% of excess deaths from March 1 to May 30, 2020 were unattributed to COVID-19. One possible source of this unaccounted excess death is out-of-hospital cardiac arrest, which corresponds to a notable decline in hospitalizations for acute cardiovascular events. Objective: To compare the number of out-of-hospital cardiac arrest (OOHCA) and dead-on-scene cases in Dallas, Texas in years prior to and during the COVID-19 pandemic. Methods: The Dallas-Fort Worth Center for Resuscitation Research Cardiac Arrest Registry provided data for this IRB-approved study. Eligible cases were non-traumatic OOHCAs who received cardiopulmonary resuscitation (CPR) from emergency medical services (EMS) providers. We compared monthly case numbers in 2017, 2018, and 2019 with case numbers in 2020 at the time of the COVID-19 pandemic in Dallas, TX. Additionally, we compared the numbers of non-traumatic deaths (declared dead on scene without receiving CPR from EMS providers) in the same timeframes. Results: While total counts of out-of-hospital cardiac arrest during the months of March to June decreased from 2017 to 2019 by 9.2% and 1.2% respectively, the number of cardiac arrest cases rose dramatically by 47.9% in 2020 (p < 0.05).(Table) The percentage of OOHCAs with an initial rhythm of asystole increased as well, from 50.1% in 2018 and 2019 to 60.4% in 2020. The total number of dead-on-scene cases was also higher in March to June 2020 than in 2017 to 2019 (NS). Conclusion: Increased out-of-hospital cardiac arrest is likely contributing to the unattributed excess deaths noted during the months of the COVID-19 pandemic in Dallas, TX. The rise in cases may be indirectly attributable to COVID-19 as cardiovascular events go untreated or treated too late.


Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Elaine L Shelton ◽  
Courtney D Berger ◽  
Michele M Salzman ◽  
Claudius Balzer ◽  
Matthias L Riess

Introduction: Despite cardiopulmonary resuscitation (CPR), more than 90% of patients having an out-of-hospital cardiac arrest in the US still die or endure severe neurological damage due to ischemia/reperfusion (IR) injury. Ventilation with Argon during CPR improves oxygenation, cardiac output, and survival in a porcine model of cardiac arrest. Similarly, inhalation of the volatile anesthetic, Sevoflurane, during CPR improves hemodynamic outcomes, but its usefulness is limited by its anesthetic effect and potential harm to providers and bystanders. In contrast, non-anesthetic noble gases like Argon can be safely administered outside of the hospital and may serve as a feasible adjuvant to mitigate IR injury following cardiac arrest. We hypothesize that Argon can decrease pulmonary and/or systemic vascular resistance, which may improve hemodynamic outcomes. Methods: Pressure myography assays were performed on isolated rat pulmonary and mesenteric arteries to determine the ability of Argon to promote vasodilation. Vessels were mounted in microvessel perfusion chambers and challenged with oxygenated Krebs buffer balanced with Argon (65%Argon:30%O 2 :5%CO 2 ) or Nitrogen (65%N 2 :30%O 2 :5%CO 2 ). Changes in intra-luminal diameter were recorded. Statistics: one-way ANOVA, p< 0.05. Results: Pulmonary arteries dilated in response to O 2 , while mesenteric arteries constricted. Argon exposure made pulmonary vessels significantly more sensitive to O 2 -induced dilation (mean Argon dilation = 133%, mean N 2 dilation = 99%). Conversely, argon blunted the ability of O 2 to constrict mesenteric arteries (argon mean constriction = 35%, nitrogen mean constriction = 41%). Conclusion: Our results indicate that Argon has vasodilatory effects in both the pulmonary and systemic circulations, making it a potentially useful therapeutic tool for mitigating IR injury following cardiac arrest or other instances of prolonged hypoperfusion. Future studies will address the mechanism underlying the ability of an inert noble gas to affect vasoactive signaling pathways.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4995-4995
Author(s):  
Tien-Chan Hsieh ◽  
Guangchen Zou ◽  
Gin Yi Lee ◽  
Pramuditha Rajapakse ◽  
Yee Hui Yeo

Abstract Background: Previous studies found the association between hereditary thrombophilia (HT) and increased risk of inpatient arterial thromboembolism, such as myocardial infarction and ischemic stroke. Nevertheless, the outcomes of hospitalized HT patients with cardiac arrest remains unclear. We aim to investigate the outcomes of inherited thrombophilia after in-hospital cardiac arrest (IHCA). Methods: This is a retrospective analysis of National Inpatient Sample database with 2016-2018 data years. We included adult (age above 18 years old) who had IHCA. IHCA, various types of HT (Factor V Leiden/activated protein C resistance, prothrombin mutation, deficiencies of antithrombin [AT] III, protein C or S deficiencies, other inherited thrombophilia), and other comorbidities were identified with International Classification of Diseases, 10th Revision, Clinical Modification Procedure Codes and Diagnosis Codes. Charlson Comorbidity Index (CCI) was used to adjust for comorbidities. Age distribution was analyzed with unpaired two-samples t-test. Gender and racial group distribution were compared with Chi-square test. Primary outcome was mortality. All independent factors associated with IHCA in inherited thrombophilia were determined by weighted multivariable logistic regression. SAS and R were used for statistical analysis. Results: Among 67,351 adult patients with IHCA, 620 patients had at least one diagnosis of HT (Factor V Leiden: 86; antithrombin III deficiency: 235; protein C/S deficiencies: 301; prothrombin gene mutation: 6; 5 cases have both factor V Leiden and protein C/S deficiencies; 3 cases have both antithrombin III and protein C/S deficiencies). Patients with HT were significant younger (mean age: 60.6 vs 65.9, p value &lt; 0.0001) with fewer comorbidities (mean CCI: 5.32 vs 5.81, p value &lt;0.0005). There was no significant difference in gender and racial groups distribution. HT was not associated with risk of mortality after IHCA (adjusted odds ratio (aOR): 0.98, Confidence interval (CI): 0.82 - 1.16, p value = 0.75). Nevertheless, subgroup analysis with different types of HT revealed increased mortality in AT III deficiency group (aOR: 1.40, CI: 1.02 - 1.91 p value &lt; 0.05). On the contrary, factor V Leiden and protein C/S deficiencies had a weak association of lower mortality (aOR: 0.70, p value &lt; 0.1; aOR: 0.80, p value = 0.06). AT III deficiency was also associated with higher risk of developing severe sepsis (aOR: 1.56, p &lt; 0.005). Myocardial infarction, ischemic stroke, pulmonary embolism, and deep venous thrombosis were not significantly associated with HT after adjusted for other potential confounders. Conclusion: HT patients who developed IHCA were younger with fewer underlying comorbidities. Only AT III deficiency subgroup was associated with higher odds of mortality and severe sepsis. Factor V Leiden and protein C/S deficiencies had a tendency of favorable outcomes. The unfavorable outcome of AT III deficiency subgroup couldn't be attributed to either arterial or venous thromboembolism. Disclosures No relevant conflicts of interest to declare.


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