Younger age is associated with higher levels of self-reported affective and cognitive sequelae six months post-cardiac arrest

Introduction: Self-reported affective and cognitive sequelae are frequently reported in cardiac arrest survivors; however, little is known about the risk factors. Hypothesis: We assessed the hypothesis that self-reported (subjective) affective and cognitive outcomes six months after OHCA may be associated with demography, acute care and cerebral outcome. Methods: This is a sub study of the multicenter “Target Temperature Management for 48 vs. 24 hours and Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial” (the TTH48 trial) investigating the effect of prolonged TTM (24h vs 48h) at 33±1°C. Patients with good outcome on the Cerebral Performances Categories (CPC score≤2) were invited to answer questionnaires on anxiety, depression, emotional distress, perceived stress and cognitive failures six months after OHCA. Multivariate regression analyses were used to test the possible predictors of self-reported outcomes six months follow-up added successively in three blocks: [1] demography (age and gender), [2] acute care (time to ROSC and allocated treatment (24h vs 48h TTM)) and [3] cerebral outcome (objective cognitive impairment and CPC score). Results: A total of 79 out of 107 eligible patients were included in the analysis. There were no significant differences in baseline characteristics between the included group and the group lost to follow-up. [1] Younger age was a significant predictor across all self-reported outcomes, even when controlling for gender, ROSC time, treatment allocation, cognitive impairment and global outcome (CPC). Female gender was a predictor of anxiety, though this should be interpreted cautiously as only eight women participated. [2] ROSC time predicted self-reported cognitive failures, when not controlling for block 3. Treatment allocation had no predictive value. [3] Objective cognitive impairment was not a predictor of self-reported affective or cognitive sequelae. The CPC score was a significant predictor of self-reported affective outcomes, albeit not for self-reported cognitive failures. Conclusion: Younger age was a significant risk factor for self-reported affective and cognitive sequelae six months post OHCA. The CPC score may be a proxy for self-reported affective outcomes.

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Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000000503 ◽

2015 ◽

Vol 16 (8) ◽

pp. 750-757 ◽

Cited By ~ 23

Author(s):

Jan Gelberg ◽

Anneli Strömsöe ◽

Jacob Hollenberg ◽

Peter Radell ◽

Andreas Claesson ◽

...

Keyword(s):

Cardiac Arrest ◽

Age Groups ◽

Younger Age ◽

Neurologic Function ◽

Hospital Cardiac Arrest

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Faculty Opinions recommendation of Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden: A 20-Year Comparison.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725679110.793527112 ◽

2017 ◽

Author(s):

Cameron Dezfulian

Keyword(s):

Cardiac Arrest ◽

Age Groups ◽

Younger Age ◽

Neurologic Function ◽

Hospital Cardiac Arrest

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Trends in Management and Mortality in Adults Hospitalized With Cardiac Arrest in the United States

Journal of Intensive Care Medicine ◽

10.1177/0885066617707921 ◽

2017 ◽

Vol 34 (3) ◽

pp. 252-258 ◽

Cited By ~ 4

Author(s):

Jignesh K. Patel ◽

Hongdao Meng ◽

Puja B. Parikh

Keyword(s):

Coronary Artery Disease ◽

Cardiac Arrest ◽

Coronary Artery ◽

Hospital Mortality ◽

Therapeutic Hypothermia ◽

The United States ◽

Coronary Angiogram ◽

Younger Age ◽

Advanced Therapies ◽

Artery Disease

Background: We sought to examine temporal trends in management (ie, use of extracorporeal membrane oxygenation [ECMO], therapeutic hypothermia [TH], coronary angiogram, and percutaneous coronary intervention [PCI]) and in-hospital mortality in adults hospitalized with cardiac arrest. Methods: Utilizing the Nationwide Inpatient Sample, medical history, clinical management, and in-hospital mortality were assessed in 942 495 hospitalizations in adults with cardiac arrest (identified through International Classification of Diseases-9 codes) from 2006 to 2012. Results: From 2006 to 2012, there was an overall rise in the use of coronary angiogram (12.8%, 13.0%, 14.7%, 15.0%, 14.3%, 14.7%, and 15.8%), PCI (7.5%, 7.1%, 8.4%, 8.1%, 8.1%, 8.4%, and 8.9%), TH (0.2%, 0.3%, 0.6%, 1.2%, 1.9%, 2.8%, and 3.0%), and ECMO (0.1%, 0.1%, 0.1%, 0.2%, 0.2%, 0.3%, and 0.4%; P < .001 for all). In-hospital mortality significantly decreased over the 7-year study period (65.5%, 63.4%, 59.3%, 57.9%, 57.0%, 56.0%, and 56.3% from 2006 to 2012). In multivariable analysis, a 31% decrease in mortality was accompanied by a concomitant 24% and 27% increase in coronary angiogram and PCI, respectively, during the study period. Therapeutic hypothermia and ECMO were associated with an approximate 11-fold and 7-fold increase, respectively, from 2006 to 2012. The strongest predictors of use of ECMO, TH, coronary angiogram, and PCI were younger age and the presence of coronary artery disease. Conclusion: During 2006 to 2012, a decline in mortality was accompanied by a steady rise in the use of ECMO, TH, coronary angiogram, and PCI in adults hospitalized with cardiac arrest. Patients of younger age and with coronary artery disease were more likely to receive these advanced therapies.

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P6380The impact of coronary artery disease to predict mortality and neurological outcome in post-cardiac arrest patients

European Heart Journal ◽

10.1093/eurheartj/ehz746.0976 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Matsuda ◽

G Nitta ◽

S Kato ◽

T Kono ◽

T Ikenouchi ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cardiac Arrest ◽

Coronary Artery ◽

Neurological Outcome ◽

Syntax Score ◽

Good Neurological Outcome ◽

Total Occlusion ◽

Younger Age ◽

Bystander Cpr ◽

Artery Disease

Abstract Background Some studies reported that performing coronary angiography (CAG) for patients with out-of-hospital cardiac arrest (OHCA) is effective for the prognosis and neurological outcome. However, the impact of complexity of coronary artery disease (CAD) on CAG findings has not been evaluated sufficiently. Purpose We sought to investigate the complexity of CAD to predict the prognosis and neurological outcome in patients with OHCA. Methods A total of 1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 252 cardiovascular arrest patients achieving the return of spontaneous circulation (ROSC) were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, we performed CAG for 160 patients. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, coronary anatomical angiographical findings. Results Ventricular fibrillation (VF) (P=0.001), younger age (P=0.007), pre-hospital ROSC (P<0.001) and normal coronary artery on CAG findings (P=0.014) were associated with low 30-days mortality in hospital. VF (P=0.003), younger age (P=0.004), pre-hospital ROSC (P<0.001), bystander cardiopulmonary resuscitation (CPR) (P=0.043) and normal coronary artery (P=0.001) were associated with good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. We further investigated 100 patients who had any coronary artery stenosis on CAG findings. Among these patients, 55 patients (55.0%) had multi-vessel coronary artery disease and 29 patients (29.0%) had at least a chronic total occlusion lesion. VF survivor (P=0.035), without previous history of CAD (P=0.008), pre-hospital ROSC (P=0.013), and Syntax score (P=0.002) were associated with low 30-days mortality. In multivariate analysis, Syntax score (OR 0.94; 95% confidence interval (CI) 0.88–0.99; P=0.042) was independent predictor of mortality. Bystander CPR (P=0.001), pre-hospital ROSC (P<0.001) were associated with good neurological outcome at 30 days. Bystander CPR (OR 5.92; 95% CI 2.01–17.5; P<0.001) and pre-hospital ROSC (OR 9.22; 95% CI 3.34–25.5; P<0.001) were predictive for good neurological outcome. Conclusions OHCA patients with any coronary stenosis had high mortality and bad neurological outcome in comparison with those who had normal coronary arteries. OHCA patients with CAD had complex lesions such as multi-vessel disease or chronic total occlusion lesions. The coronary complexity in patients with OHCA was a predictor of in-hospital 30-days mortality. However, pre-hospital care such as bystander CPR and pre-hospital ROSC were the most important to achieve good neurological outcome at 30 days in the present study.

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Pediatric cardiac arrest in the emergency department: Outcome is related to the time of admission

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.487 ◽

2019 ◽

Vol 35 (5) ◽

Author(s):

Ali Yurtseven ◽

Caner Turan ◽

Funda Karbek Akarca ◽

Eylem Ulaş Saz

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Survival Rates ◽

Working Hours ◽

Patient Characteristics ◽

Spontaneous Circulation ◽

Creative Commons ◽

Younger Age ◽

Time Of Admission

Objectives: Nights and weekends represent a potentially high-risk time for pediatric cardiac arrest (CA) patients in emergency departments. Data regarding night or weekend arrest and its impact on outcomes is controversial. The purpose of this study was to determine the relationship between cardiopulmonary resuscitation during the various emergency department shifts and survival to discharge. Methods: We conducted a retrospective, observational study of patients who had visited our Emergency Department for CAs from January 2014 to December 2016. Medical records and patient characteristics of 67 children with CA were retrieved from patient admission files. Results: The mean age was 54.7±7.3 months and 59% were male. Rates of survival to discharge 35% (11/31) within working hours’ vs. out of working hours 3% (1/36). Among the CAs presenting to the emergency department, the survival rates were higher for working hours than for non-working hours (OR: 37.6 (2.62-539.7), p: 008). The rate of return of spontaneous circulation within working hours was higher than that of non-working hours (71% vs.19%) (p<0.001). Patients who received chest compression for more than 10 minutes had the lowest survival rate (2%) (p<0.001), whereas better outcome was associated with in-hospital CA, younger age (less than 12 months) and respiratory failure. Conclusion: Survival rates from pediatric CAs were significantly lower during non-working hours. Poor outcome was associated with prolonged cardiopulmonary resuscitation, out of hospital CA and older age. doi: https://doi.org/10.12669/pjms.35.5.487 How to cite this:Yurtseven A, Turan C, Akarca FK, Saz EU. Pediatric cardiac arrest in the emergency department: Outcome is related to the time of admission. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.487 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comparison of Two Protocols for Pulseless Cardiopulmonary Arrest: Vasopressin Combined with Epinephrine Versus Epinephrine Alone

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00008499 ◽

2010 ◽

Vol 25 (5) ◽

pp. 420-423 ◽

Cited By ~ 4

Author(s):

Patrick Cody ◽

Sean Lauderdale ◽

David E. Hogan ◽

Robert R. Frantz

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Cardiopulmonary Arrest ◽

Inclusion Criteria ◽

Discharge Data ◽

Emergency Department Arrival ◽

Discharge Home ◽

Electrical Therapy ◽

Younger Age ◽

Microsoft Office

AbstractIntroduction:Survival from pulseless cardiac arrest typically is dismal. Some suggest that adding vasopressin to epinephrine as a cardiovascular stimulant can improve outcomes.Problem:This study compares survival outcomes using epinephrine verses vasopressin and epinephrine in persons with pulseless cardiac arrest.Methods:This is a retrospective, cohort evaluation of two resuscitative protocols (P1-epinephrine or P2-vasopressin with epinephrine) in a tiered response, community emergency medical service (EMS) with an approximately 100,000 catchment area. Cases are defined as 18 years or older determined to be in pulseless cardiac arrest. Outcomes were survival to emergency department arrival, to 24 hours, and to hospital discharge. Data were entered into Microsoft Office Excel® and processed using Analyze-it® for continuous and categorical data and Epi-Info® for odds ratios with confidence intervals.Results:There were 204 cases (60.3% males and 39.7% females) who met the inclusion criteria. Thirteen cases received electrical therapy only, and were dropped from analysis, leaving 191 (93.6%) who were included in the study; P1 to 85 (44.5%) and P2 to 106 (55.5%). Younger age was associated with improved survival to discharge home in both protocols, p = 0.003 (95% CI = 0.004–0.010). No difference in survival was noted at the levels of emergency department arrival OR 1.42 (95% CI = 0.73, 2.76) p = 0.26; 24 hour survival OR 0.54 (95% CI = 0.22–1.30) p = 0.133, or discharge home OR = 1.81 (95% CI = 0.49–6.88) p = 0.319.Conclusions:This study in a community EMS did not demonstrate improved survival with the addition of vasopressin to epinephrine for pulseless cardiac arrest.

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Cardiac arrest in patients hospitalized for COVID-19: a tertiary medical center retrospective cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0292 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Luo ◽

J M Du-Fay-De-Lavallaz ◽

J M D Gomez ◽

S Fugar ◽

L Golemi ◽

...

Keyword(s):

Cardiovascular Disease ◽

Logistic Regression ◽

Cardiac Arrest ◽

Cohort Study ◽

Hospital Discharge ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Medical Center ◽

Younger Age ◽

Hospital Cardiac Arrest

Abstract Background/Introduction Patients with COVID-19 are at increased risk for mortality during hospitalization. Better definition of the incidence, predictors, and outcomes of cardiac arrest during hospitalization for COVID-19 may support early identification and intervention. Purpose To estimate the incidence of in-hospital cardiac arrest in patients with COVID-19, describe the temporal trends in incidence of and survival after cardiac arrest, summarise characteristics of those who experienced a cardiac arrest, and compare the characteristics of survivors versus non-survivors of cardiac arrest. Methods We conducted a retrospective cohort study of patients admitted for COVID-19 to a tertiary medical center comprising three hospitals between March and November 2020. Data entry is ongoing for more than 2000 patients admitted through 2021. Clinical variables extracted via review of electronic medical records included age, sex, race/ethnicity, body mass index, history of cardiovascular disease (ie., coronary artery disease, congestive heart failure, atrial fibrillation, or cerebrovascular event), other comorbidities included in the Charlson comorbidity index, date of admission, duration of hospitalization, all cardiac arrest events during hospitalization, presenting rhythm during first cardiac arrest, and death. Data were described using summary statistics. Multivariable logistic regression was used to evaluate associations. Results Among 1666 patients, 107 (6.4%) experienced at least one in-hospital cardiac arrest event during hospitalization for COVID-19, of which 25 (23%) survived to hospital discharge. From March to October 2020, there was a decrease in estimated cardiac arrest incidence in-hospital from 8.2% to 3%, whereas estimated survival to hospital discharge after an arrest remained similar at approximately 20% (Figure). Compared to those who did not, patients who experienced in-hospital cardiac arrest were older and more likely to have existing cardiovascular disease, as well as other comorbidities. Similar factors were associated with lower chance of survival after cardiac arrest (Table). Patients with pulseless ventricular tachycardia/fibrillation (VT/VF) as presenting rhythm in cardiac arrest had better survival to hospital discharge compared to those with other rhythms (OR 3.3, p=0.02). Younger age (per 10 years, OR=0.7, p=0.03) and fewer comorbidities (per one fewer comorbidity, OR=1.5, p=0.05) were associated with better survival after cardiac arrest in multivariable logistic regression. Conclusion There was a decline in estimated incidence of cardiac arrest during hospitalization for COVID-19 since beginning of pandemic, with survival to hospital discharge after cardiac arrest estimated to be stable at around 20%. Younger age and fewer comorbidities especially cardiovascular disease were associated with better survival after an in-hospital cardiac arrest. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Rush University Medical Center Figure 1 Table 1

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Abstract 299: Out-of-Hospital Cardiac Arrest: A 25 Years Registry

Circulation ◽

10.1161/circ.138.suppl_2.299 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Margot Cassuto ◽

Armelle Severin ◽

Cecile Ursat ◽

Anna Ozguler ◽

Michel Baer ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Public Awareness ◽

Age Groups ◽

Heart Association ◽

Spontaneous Circulation ◽

Age Group ◽

Younger Age ◽

Cardio Vascular ◽

Hospital Cardiac Arrest

Introduction: For many years, organizations like American Heart Association (AHA) published guidelines for the management of Out-of-Hospital Cardiac Arrest (OHCA). Our Emergency Medical Service (EMS), in a catchment of 500,000 inhabitants, has registered all OHCA since 1993. The aim of this study was to describe evolution of the on scene return of spontaneous circulation (ROSC) after OHCA from cardio-vascular cause (CV) over the past years. Methods: Data were collected from an EMS registry since 1993. The study included adult patients with OHCA from CV. Collected data were evolution (death or ROSC), gender, age group (older than 15) and periods (1993-1999, 2000-2004, 2005-2009, 2010-2014, 2015-2017). The primary outcome was rate of on scene ROSC. Comparisons were performed with Chi-2 test and logistic regression. Results: The registry included 8761 adults with OHCA, 7165 (82.2%) of which had a CV. Mean age was 71.6 years old (SD 16.9), 58.7% were male. ROSC rate was 15.2%. ROSC increased from 10.3% before 2000 to 19.8% after 2015, addressing significantly all age groups except the oldest (figure 1). ROSC rate was 17% for men and 12% for women. Logistic regression results (adjusted and not) showed a greater chance of ROSC for younger patients (OR ranging from 2.1 for age group 60-74 until 4.3 for 16-29 age group, compared with ≥ 75 age group), if OHCA occurred recently (OR ranging from 1.5 for 2010-214 period to 2.6 for < 2000 period compared with ≥ 2015) and for males (OR=1.3). Conclusion: This study shows increase of ROSC after OHCA, mainly for younger age groups, during this last 25 years. This may be due to evolution of public awareness and medical practice according to guidelines. In addition, women did not benefit from this evolution as much as men did. In the future, as the "Go Red for Women" campaign, efforts to improve survival of OHCA should focus on women.

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Abstract 325: Characteristics and Outcomes of Hanging Induced Out-Of-Hospital Cardiac Arrest: Insights From the Paris Sudden Death Expertise Center Registry

Circulation ◽

10.1161/circ.140.suppl_2.325 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Arnaud Gille ◽

Richard Chocron ◽

Anna Ozguler ◽

Xavier JOUVEN ◽

Alain Cariou ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Spontaneous Circulation ◽

Low Flow ◽

Flow Duration ◽

Shockable Rhythm ◽

Younger Age ◽

Bystander Cardiopulmonary Resuscitation ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Introduction: Hanging-induced Out-of-Hospital cardiac arrest (OHCA) is poorly studied and a better understanding of these specific OHCA could be helpful to improve patients’ outcome. The main objective of our study was to describe characteristics and outcomes in patients who had OHCA from hanging injuries. Methods: From May 2011 to December 2017 we analyzed a prospectively collected Utstein database for all OHCA adults. All cases due to hanging were included. Utstein style variables were compared for 2 groups of patients: those with a Return of Spontaneous Circulation (ROSC) and those without (non-ROSC). Continuous data are described as means (extremes). Results: Among 25 055 OHCA, 500 patients were included. They were 49 (18-100) years old. Seventy-three (14.6%) hanging were witnessed and 58 (11.6%) benefited from a bystander cardiopulmonary resuscitation before Emergency Medical Service (EMS) arrival. No-flow duration was 29.1 (4-180) minutes. Advance life support was initiated by EMS in 299 (59.8%) cases. Low-flow duration was 23.8 (2-79) minutes. Nine patients (1.8%) had a shockable initial rhythm. We observed 83 (16.6%) ROSC. Four (0.8%) patients were discharged alive from hospital. They were all CPC 1. Table 1 compares characteristics with significant differences between ROSC and non-ROSC groups. Conclusion: As expected, younger age, short no-flow and low-flow durations and shockable rhythm on EMS arrival were significantly associated with ROSC. Overall prognosis is dramatically poor when OHCA is due to hanging (<1%), with a very low proportion of shockable rhythm, even if the rare survivors have an excellent CPC at discharge. Indeed, the best method to reduce the mortality rate of hanging is, with no contest, the prevention of suicidal act.

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