scholarly journals Multiple cluster analysis for the identification of high-risk census tracts for out-of-hospital cardiac arrest (OHCA) in Denver, Colorado

Resuscitation ◽  
2014 ◽  
Vol 85 (12) ◽  
pp. 1667-1673 ◽  
Author(s):  
Ariann F. Nassel ◽  
Elisabeth D. Root ◽  
Jason S. Haukoos ◽  
Kevin McVaney ◽  
Christopher Colwell ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Cardiac Arrest ◽  
High Risk ◽  
Census Tracts ◽  
Hospital Cardiac Arrest ◽  
Multiple Cluster

Detection of high risk mortality areas after in-hospital cardiac arrest

Resuscitation ◽  
2010 ◽  
Vol 81 (2) ◽  
pp. S35
Author(s):  
J.J. Egea-Guerrero ◽  
I. Maira-Gonzalez ◽  
C. Palacios-Gómez ◽  
A. Vilches-Arenas ◽  
E. Montero-Romero ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Hospital Cardiac Arrest

Abstract 183: School-Centered CPR Education to Improve Survival from Out-of-Hospital Cardiac Arrest in High-Risk Neighborhoods

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tom Califf ◽  
René Ramon ◽  
Wendy Morrison ◽  
Ariann Nassel ◽  
Comilla Sasson
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Low Income ◽  
Skills Training ◽  
Seventh Grade ◽  
Post Intervention ◽  
Train The Trainer ◽  
The People ◽  
Cpr Training ◽  
Hospital Cardiac Arrest

Background: Low-income and Latino neighborhoods are at high risk for having low provision of bystander CPR for victims of out-of-hospital cardiac arrest (OHCA). Novel community-based intervention is needed in these neighborhoods to increase awareness of CPR techniques and, ultimately, to decrease mortality from OHCA. Objective: To determine the feasibility of a train-the-trainer hands-only CPR program as a required assignment in a middle school. Methods: Design: Prospective survey-based interventional study. Setting: Public charter school in the Denver, CO metropolitan area. Population: Cohort of 118 subjects was recruited out of 134 eligible seventh grade students. Observations: Participants completed a 6-question test to assess baseline knowledge of CPR. Subjects then completed a group hands-only CPR training lasting 1 hour using the CPR Anytime kit, which included both an educational DVD and hands-on practical skills training with an inflatable mannequin. Participants were then asked to use these kits to train other community members over a 2-week period. At the end of the study, students were asked to complete the same 6-question survey to assess their retention of knowledge. Two-sample t-tests were conducted to assess for differences in hands-only CPR knowledge pre- and post-CPR training. Results: Demographics are given for the entire seventh grade class ( Table 1 ). Students were mostly white (71.6%), and 11 (8.2%) participated in the Free & Reduced Lunch program. Of 134 seventh graders attending the school, 118 (88%) completed a pre-intervention survey and 74 (55%) completed a post-intervention survey. Between the surveys, the mean number of questions answered correctly increased ( Table 2 ), as did performance on the question asking where to place AED pads on the chest (p < .001). Students performed poorest in both pre- and post-testing on identifying the appropriate situation for performing hands-only CPR. Conclusion: Implementation of a school-based train-the-trainee CPR education program is a feasible endeavor. Students demonstrated increased knowledge of CPR techniques two weeks after training compared to baseline. Future studies will need to be conducted to assess the people who are then trained by these students using the CPR Anytime Kits.

Abstract 55: The CAHP (Cardiac Arrest Hospital Prognosis) Score: Predicting Neurological Outcome After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Carole Maupain ◽  
Wulfran Bougouin ◽  
Lamhaut Lionel ◽  
Nicolas Deye ◽  
Daniel Jost ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Neurological Outcome ◽  
Risk Group ◽  
Unfavorable Outcome ◽  
Validation Dataset ◽  
Group Score ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Prognosis Score

Background: Out-of-hospital cardiac arrest (OHCA) carries a very poor prognosis. Early prognostication of patients admitted in ICU after resuscitated OHCA is a key issue but remains challenging. The aim of that study was to establish a new scoring system to predict poor neurological outcome in these patients. Materials and Methods: The CAHP (Cardiac Arrest Hospital Prognosis) score was developed from the Sudden Death Expertise Center registry (SDEC, Paris, France). Objective risk factors were weighted on the basis of a logistic regression analysis. The primary outcome was poor neurological outcome defined as Cerebral Performance Category 3, 4 or 5. Thresholds were defined to distinguish low, moderate and high-risk groups. The CAHP score was then validated in an external dataset (Parisian OHCA Registry). Score calibration and discrimination characteristics were assessed in the validation dataset. Results: The developmental dataset included 819 patients admitted in ICU from May 2011 to December 2012. After logistic regression, 7 variables were independently associated with poor neurological outcome: age, initial shockable rhythm, time form collapse to basic life support (BLS), time from BLS to return of spontaneous circulation (ROSC), location of cardiac arrest, epinephrine dose during resuscitation and arterial pH at admission. These variables were included in the CAHP score. 3 risks groups were identified: a low risk group (score ≤ 150, 39 % of unfavorable outcome), medium risk group (score 150-200, 81% of unfavorable outcome) and high-risk group (CAHP score ≥ 200, 100 % of unfavorable outcome). AUC of the CAHP score was 0.93. In the external validation dataset, discrimination value of the CAHP score was consistent with an AUC of 0.85. Conclusion: The CAHP score is a simple and objective tool for early assessment of prognosis in patients admitted to ICU after OHCA. Moreover it allows to stratify the probability of poor neurological outcome by identifying a very high-risk category of patients (score ≥ 200).

Abstract 187: Cardiac Arrest Incidence, Bystander Cardiopulmonary Resuscitation Rates, and Community Characteristics Differ by High and Low Risk Areas

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Rebecca Cash ◽  
Madison K Rivard ◽  
Eric Cortez ◽  
David Keseg ◽  
Ashish Panchal
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Cardiopulmonary Resuscitation ◽  
Low Risk ◽  
Poverty Level ◽  
Community Characteristics ◽  
Franklin County ◽  
Census Tracts ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Risk Areas

Introduction: Survival from out-of-hospital cardiac arrest (OHCA) has significant variation which may be due to differing rates of bystander cardiopulmonary resuscitation (BCPR). Defining and understanding the community characteristics of high-risk areas (census tracts with low BCPR rates and high OHCA incidence) can help inform novel interventions to improve outcomes. Our objectives were to identify high and low risk census tracts in Franklin County, Ohio and to compare the OHCA incidence, BCPR rates, and community characteristics. Methods: This was a cross-sectional analysis of OHCA events treated by Columbus Division of Fire in Franklin County, Ohio from the Cardiac Arrest Registry to Enhance Survival between 1/1/2010-12/31/2017. Included cases were 18 and older, with a cardiac etiology OHCA in a non-healthcare setting, with EMS resuscitation attempted. After geocoding to census tracts, Local Moran’s I and quartiles were used to determine clustering in high risk areas based on spatial Empirical Bayes smoothed rates. Community characteristics, from the 2014 American Community Survey, were compared between high and low risk areas. Results: From the 3,841 included OHCA cases, the mean adjusted OHCA incidence per census tract was 0.67 per 1,000 with a mean adjusted BCPR rate of 31% and mean adjusted survival to discharge of 9.4%. In the 25 census tracts identified as high-risk areas, there were significant differences in characteristics compared to low-risk areas, including a higher proportion of African Americans (64% vs. 21%, p<0.001), lower median household income ($30,948 vs. $54,388, p<0.001), and a higher proportion living below the poverty level (36% vs. 20%, p<0.001). There was a 3-fold increase in the adjusted OHCA incidence between high and low risk areas (1.68 vs. 0.57 per 1,000, p<0.001) with BCPR rates of 27% and 31% (p=0.31), respectively. Compared to a previous analysis, 9 (36%) census tracts persisted as high-risk but an additional 16 were newly identified. Conclusions: Neighborhood-level variations in OHCA incidence are dramatic with marked disparities in characteristics between high and low risk areas. It is possible that improving OHCA outcomes requires multifaceted interventions to address social determinants of health.

Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest

2019 ◽  
pp. bmjspcare-2019-001828
Author(s):  
Mia Cokljat ◽  
Adam Lloyd ◽  
Scott Clarke ◽  
Anna Crawford ◽  
Gareth Clegg
Keyword(s):  
At Risk ◽  
Palliative Care ◽  
Cardiac Arrest ◽  
High Risk ◽  
Low Risk ◽  
Intermediate Risk ◽  
Patients At Risk ◽  
Risk Patients ◽  
Record Review ◽  
Hospital Cardiac Arrest

ObjectivesPatients with indicators for palliative care, such as those with advanced life-limiting conditions, are at risk of futile cardiopulmonary resuscitation (CPR) if they suffer out-of-hospital cardiac arrest (OHCA). Patients at risk of futile CPR could benefit from anticipatory care planning (ACP); however, the proportion of OHCA patients with indicators for palliative care is unknown. This study quantifies the extent of palliative care indicators and risk of CPR futility in OHCA patients.MethodsA retrospective medical record review was performed on all OHCA patients presenting to an emergency department (ED) in Edinburgh, Scotland in 2015. The risk of CPR futility was stratified using the Supportive and Palliative Care Indicators Tool. Patients with 0–2 indicators had a ‘low risk’ of futile CPR; 3–4 indicators had an ‘intermediate risk’; 5+ indicators had a ‘high risk’.ResultsOf the 283 OHCA patients, 12.4% (35) had a high risk of futile CPR, while 16.3% (46) had an intermediate risk and 71.4% (202) had a low risk. 84.0% (68) of intermediate-to-high risk patients were pronounced dead in the ED or ED step-down ward; only 2.5% (2) of these patients survived to discharge.ConclusionsUp to 30% of OHCA patients are being subjected to advanced resuscitation despite having at least three indicators for palliative care. More than 80% of patients with an intermediate-to-high risk of CPR futility are dying soon after conveyance to hospital, suggesting that ACP can benefit some OHCA patients. This study recommends optimising emergency treatment planning to help reduce inappropriate CPR attempts.

scholarly journals Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

2020 ◽  
Author(s):  
Diana A Gorog ◽  
Susanna Price ◽  
Dirk Sibbing ◽  
Andreas Baumbach ◽  
Davide Capodanno ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Antithrombotic Therapy ◽  
Left Ventricular ◽  
Position Paper ◽  
Ventricular Assist Devices ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Timely and effective antithrombotic therapy is critical to improving outcome, including survival, in patients with acute coronary syndrome (ACS). Achieving effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in high-risk ACS patients, especially those with cardiogenic shock (CS) or those successfully resuscitated following out-of-hospital cardiac arrest (OHCA), who have a 30-50% risk of death or a recurrent ischaemic event over the subsequent 30 days. There are unique challenges to achieving effective and safe antithrombotic treatment in this cohort of patients that are not encountered in most other ACS patients. This position paper focuses on patients presenting with CS or immediately post-OHCA, of presumed ischaemic aetiology, and examines issues related to thrombosis and bleeding risk. Both the physical and pharmacological impacts of CS, namely impaired drug absorption, metabolism, altered distribution and/or excretion, associated multiorgan failure, co-morbidities and co-administered treatments such as opiates, targeted temperature management, renal replacement therapy and circulatory or left ventricular assist devices, can have major impact on the effectiveness and safety of antithrombotic drugs. Careful attention to the choice of antithrombotic agent(s), route of administration, drug-drug interactions, therapeutic drug monitoring and factors that affect drug efficacy and safety, may reduce the risk of sub- or supra-therapeutic dosing and associated adverse events. This paper provides expert opinion, based on best available evidence, and consensus statements on optimising antithrombotic therapy in these very high-risk patients, in whom minimising the risk of thrombosis and bleeding is critical to improving outcome.

2285Increased risk of out-of-hospital cardiac arrest associated with psychiatric disorders

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C A Barcella ◽  
G H Mohr ◽  
K Kragholm ◽  
D M Christensen ◽  
C Polcwiartek ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Cardiac Arrest ◽  
High Risk ◽  
General Population ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Psychiatric Disorders ◽  
Index Date ◽  
Psychiatric Patients ◽  
Hospital Cardiac Arrest

Abstract Introduction Patients with psychiatric disorders are at high risk of cardiovascular morbidity and mortality; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared to the general population remains unknown. Purpose We investigated whether the presence and severity of different psychiatric disorders were associated with a higher risk of OHCA. Methods We conducted a case-control study matching all adult patients with OHCA of presumed cardiac cause between 2001 and 2014 with up to nine controls from the entire Danish population on age, sex and ischemic heart disease (IHD). Patients with psychiatric disorders were identified using in- and out-patient hospital diagnoses – both primary and secondary - before index date. We identified six mutually exclusive psychiatric disorders that were separately examined: personality disorders, anxiety, substance-related mental disorders, depression, bipolar disorder and schizophrenia. The risk of OHCA associated with the six psychiatric disorders was evaluated by conditional logistic regression adjusting for comorbidities, concomitant pharmacotherapy, socioeconomic status and marital status. Results We included 32,447 OHCA cases matched with 291,999 controls from the general population. Overall, the median age was 72 years, 67% were male and 29% had IHD prior to index date. All the six psychiatric disorders examined were more common among cases than controls; depression was the most common psychiatric disorders in both groups: 5.0% among cases and 2.8% among controls. Concurrently, all six psychiatric disorders were associated with significantly higher odds of OHCA: personality disorders (odds ratio (OR) 1.30 [95% confidence interval (CI) 1.06–1.60], anxiety OR 1.26 [95% CI 1.15–1.39], substance induced-mental disorders OR 2.36 [95% CI 2.17–2.57], depression OR 1.27 [95% CI 1.19–1.35], bipolar disorder OR 1.32 [95% CI 1.16–1.50] and schizophrenia OR 1.80 [95% CI 1.58–2.05] (Figure). The association persisted unaffected when we studied psychiatric patients neither exposed to antipsychotics nor to antidepressants. We observed a trend towards a stronger association when we stratified according to the severity of the psychiatric disorder (Figure). Severe disorders where classified as at least one hospitalization for the specific psychiatric illness as primary diagnosis during the five years prior to index date. Conclusions Common psychiatric disorders including personality disorders, anxiety, substance-related mental disorders, depression, bipolar disorder and schizophrenia are significantly associated with higher odds of OHCA. These findings provide a rationale for early cardiovascular risk factor screening and, potentially, management among psychiatric patients to identify patients at high risk of OHCA. Acknowledgement/Funding ESCAPE-NET project

scholarly journals Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry

2021 ◽  
Vol 10 (3) ◽  
pp. 439
Author(s):  
Hwan Song ◽  
Hyo Kim ◽  
Kyu Park ◽  
Soo Kim ◽  
Won Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Coronary Angiography ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
High Risk Patients ◽  
Neurologic Outcomes ◽  
Risk Patients ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

The effect of early coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation (STE) is still controversial. It is not known which subgroups of patients without STE are the most likely to benefit. The objective of this study was to evaluate the association between emergency CAG and neurologic outcomes and identify subgroups with improved outcomes when emergency CAG was performed. This prospective, multicenter, observational cohort study was based on data from the Korean Hypothermia Network prospective registry (KORHN-PRO) 1.0. Adult OHCA patients who were treated with targeted temperature management (TTM) without any obvious extracardiac cause were included. Patients were dichotomized into early CAG (≤24 h) and no early CAG (>24 h or not performed) groups. High-risk patients were defined as having the Global Registry of Acute Coronary Events (GRACE) score > 140, time from collapse to return of spontaneous circulation (ROSC) > 30 min, lactate level > 7.0 mmol/L, arterial pH < 7.2, cardiac enzyme elevation and ST deviation. The primary outcome was good neurologic outcome at 6 months after OHCA. Of the 1373 patients from the KORHN-PRO 1.0 database, 678 patients met the inclusion criteria. The early CAG group showed better neurologic outcomes at 6 months after cardiac arrest (CA) (adjusted odds ratio: 2.21 (1.27–3.87), p = 0.005). This was maintained even after propensity score matching (adjusted odds ratio: 2.23 (1.39–3.58), p < 0.001). In the subgroup analysis, high-risk patients showed a greater benefit from early CAG. In contrast, no significant association was found in low-risk patients. Early CAG was associated with good neurologic outcome at 6 months after CA and should be considered in high-risk patients.

Abstract 136: Disparities in Out of Hospital Cardiac Arrest Care and Outcomes in Texas

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Ryan Huebinger ◽  
Henry Wang ◽  
Jeff Jarvis ◽  
Cameron Decker ◽  
Robert Dickson ◽  
...  
Keyword(s):  
High School ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Census Tract ◽  
High School Graduation ◽  
Census Tracts ◽  
Bystander Cpr ◽  
School Graduation ◽  
Racial Ethnic ◽  
Hospital Cardiac Arrest

Background: Minorities and impoverished persons experience disparities in access to healthcare. Large inequalities in out-of-hospital cardiac arrest (OHCA) care have been described. We sought to characterize racial and socioeconomic disparities in OHCA care and outcomes in Texas. Hypothesis: There are census tract level disparities in OHCA care and outcomes in Texas. Methods: We analyzed Texas-Cardiac Arrest Registry to Enhance Survival (CARES) data from 13 EMS agencies providing care in 15 counties to roughly 30% of the state population. We included all adult (>=18 year) OHCA from 1/1/14 through 12/31/18 with complete data. Using census tract data, we stratified census tracts into racial/ethnic categories: >50% non-Hispanic/Latino white, >50% black, and >50% Hispanic/Latino. We also stratified census tracts into neighborhoods above and below the median for socioeconomic characteristics: household income, employment rate, and high school graduation. We defined outcomes as bystander CPR rates, public bystander AED use, and survival to hospital discharge. Using mixed models, we analyzed the associations between outcomes and neighborhood (1) racial/ethnic categories and (2) socioeconomic categories. Results: We included data on 18,487 OHCAs from 1,727 census tracts. Relative to white neighborhoods, black neighborhoods had a significantly lower rate of bystander AED use (OR 0.3, CI 0.1-0.9), and Latino neighborhoods had a lower rate of bystander CPR (OR 0.7, CI 0.6-0.8), bystander AED use (OR 0.4, CI 0.3-0.6) and survival to hospital discharge (OR 0.9, CI 0.8-0.98). Lower income was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.8), bystander AED use (OR 0.5, 0.4-0.8), and survival to hospital discharge (OR 0.6, CI 0.5-0.9). Lower high school graduation was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.9) and bystander AED use (OR 0.6, CI 0.4-0.9). High unemployment was associated with lower rates of bystander CPR (OR 0.9, CI 0.8-0.94) and bystander AED use (OR 0.7, CI 0.5-0.99). Conclusion: Minority and poor neighborhoods in Texas experience large and unacceptable disparities in OHCA bystander response and outcomes. These data present an important opportunity for targeted resuscitation training and quality improvement.

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