scholarly journals Fewer Tracheal Intubation Attempts are Associated with Improved Neurologically Intact Survival Following Out-of-Hospital Cardiac Arrest

Resuscitation ◽  
2021 ◽  
Author(s):  
David L. Murphy ◽  
Natalie E. Bulger ◽  
Brenna M. Harrington ◽  
Jillian A. Skerchak ◽  
Catherine R. Counts ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

scholarly journals Blood gas phenotyping and tracheal intubation timing in adult in-hospital cardiac arrest: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chih-Hung Wang ◽  
Meng-Che Wu ◽  
Cheng-Yi Wu ◽  
Chien-Hua Huang ◽  
Min-Shan Tsai ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Interaction Analysis ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Optimal Time ◽  
Hypercapnic Acidosis ◽  
Blood Gas ◽  
Regression Analyses ◽  
Hospital Cardiac Arrest

AbstractTo investigate whether the optimal time to tracheal intubation (TTI) during cardiopulmonary resuscitation would differ by different blood gas phenotypes. Adult patients experiencing in-hospital cardiac arrest (IHCA) from 2006 to 2015 were retrospectively screened. Early intra-arrest blood gas analysis, performed within 10 min of resuscitation, was used to define different phenotypes. In total, 567 patients were included. Non-severe acidosis (pH≧7.15) was associated with favourable neurological outcome (odds ratio [OR]: 4.60, 95% confidence interval [CI] 1.63–12.95; p value = 0.004) and survival (OR: 3.25, 95% CI 1.72–6.15; p value < 0.001) in the multivariable logistic regression analyses. In the interaction analysis, normal blood gas phenotype (pH: 7.35–7.45, PCO2: 35–45 mm Hg, HCO3− level: 22–26 mmol/L) × TTI ≦ 6.3 min (OR: 20.40, 95% CI 2.53–164.75; p value = 0.005) and non-severe acidosis × TTI ≦ 6.3 min (OR: 3.35, 95% CI 1.00–11.23; p value = 0.05) were associated with neurological recovery while metabolic acidosis × TTI ≦ 5.7 min (OR: 3.63, 95% CI 1.36–9.67; p value = 0.01) and hypercapnic acidosis × TTI ≦ 10.4 min (OR: 2.27, 95% CI 1.20–4.28; p value = 0.01) were associated with survival. Intra-arrest blood gas analysis may help guide TTI during for patients with IHCA.

Abstract 264: The Association of Chest Compression Fraction and Clinical Outcomes from Shockable Out-of-Hospital Cardiac Arrest During the Resuscitation Outcomes Consortium Primed Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheldon Cheskes ◽  
Robert H Schmicker ◽  
Tom Rea ◽  
Judy Powell ◽  
Ian R Drennan ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Clinical Outcomes ◽  
Chest Compression ◽  
Reference Group ◽  
Secondary Analysis ◽  
Process Data ◽  
Shockable Rhythm ◽  
The Relationship ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

INTRODUCTION: The role of chest compression fraction (CCF) in resuscitation of shockable out-of-hospital cardiac arrest (OHCA) is uncertain. We evaluated the relationship between CCF and clinical outcomes in a secondary analysis of the Resuscitation Outcomes Consortium (ROC) PRIMED trial. METHODS: We included OHCA patients from the ROC PRIMED trial who suffered cardiac arrest prior to EMS arrival, presented with a shockable rhythm, and had cardiopulmonary resuscitation (CPR) process data for at least one shock. We used multivariable logistic regression adjusting for Utstein variables, CPR metrics of compression rate and perishock pause, and ROC site to determine the relationship between CCF and survival to hospital discharge, return of spontaneous circulation (ROSC), and neurologically intact survival defined with Modified Rankin Score (MRS) ≤ 3. Due to potential confounding between CCF and cases that achieved early ROSC, we also performed an analysis restricted to patients without ROSC in the first 10 minutes of EMS resuscitation. RESULTS: Among the 2,558 eligible patients, median (IQR) age was 65 (54, 76) years, 76.9% were male, and mean (SD) CCF was 0.70 (0.15). Compared to the reference group (CCF < 0.60), the odds ratio (OR) for survival was 0.57 (95%CI: 0.42, 0.78) for CCF 0.60-0.79 and 0.32 (95%CI: 0.22, 0.48) for CCF ≥0.80. Results were similar for outcomes of ROSC and neurologically intact survival. Conversely, when restricted to the cohort who did not achieve ROSC during the first 10 minutes (n=1,660), the relationship between CCF and survival was no longer significant. Compared to the reference group (CCF < 0.60), the OR for survival was 0.85 (95 %CI: 0.58, 1.26) for CCF 0.60-0.79 and OR 0.87 (95%CI: 0.58, 1.36) for CCF ≥0.80. CONCLUSIONS: In this observational cohort study of OHCA patients presenting in a shockable rhythm, CCF when adjusted for Utstein predictors, CPR metrics and ROC site was paradoxically associated with lower odds of survival. The relationship between CCF and clinical outcomes was null in a sensitivity analysis restricted to patients without ROSC in the first 10 minutes. CCF is a complex measure and taken by itself may not be a consistent predictor of clinical outcome.

Out of Hospital Cardiac Arrest

2018 ◽  
pp. 89-93
Author(s):  
Erik Rueckmann
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Evidence Based ◽  
Early Defibrillation ◽  
Key Factors ◽  
High Quality ◽  
Key Points ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

The management of out-of-hospital, atraumatic cardiac arrest has changed over the past decade. This case details the evidence-based changes in care that optimize the chance of neurologically intact survival. The key factors include immediate, continuous, high-quality cardiopulmonary resuscitation with minimal interruptions, early defibrillation, and the use of capnography to assess resuscitative efforts. The orchestration of resuscitative efforts is a bundle of care that must all be met to provide the patient the best chance of survival. Furthermore, this case illustrates the key points of postarrest care and touches on termination of resuscitation. This chapter examines the case of emergency medical services call for an unresponsive patient in cardiac arrest on arrival.

Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study

2019 ◽  
Vol 35 (1) ◽  
pp. 17-23
Author(s):  
Julian G. Mapp ◽  
Anthony M. Darrington ◽  
Stephen A. Harper ◽  
Chetan U. Kharod ◽  
David A. Miramontes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Hospital Discharge ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
San Antonio ◽  
Cerebral Performance Category ◽  
Published Data ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

AbstractIntroduction:To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.Methods:This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).Results:Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).Conclusion:This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.

scholarly journals Factors Associated With Neurologically Intact Survival for Patients With Acute Heart Failure and In-Hospital Cardiac Arrest

2009 ◽  
Vol 2 (6) ◽  
pp. 572-581 ◽  
Author(s):  
Phillip D. Levy ◽  
Hong Ye ◽  
Scott Compton ◽  
Paul S. Chan ◽  
Gregory Luke Larkin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Acute Heart Failure ◽  
Factors Associated ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

P492Estimation of no-flow duration and survival in patients with an initial shockable rhythm after out-of-hospital cardiac arrest

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
F Okada ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Flow Duration ◽  
Shockable Rhythm ◽  
Number Of Patients ◽  
Initial Rhythm ◽  
The Relationship ◽  
Neurologically Intact ◽  
Utstein Style ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999) Background In patients with unwitnessed out-of-hospital cardiac arrest (OHCA), the actual no-flow duration (the time with no organ perfusion) is unclear. However, when these patients have a shockable rhythm as an initial recorded rhythm, the no-flow duration may be relatively short as compared with other initial rhythms, and some patients can obtain a good functional outcome after OHCA. Purpose The purpose of the present study was to estimate the no-flow duration and to determine the relationship between no-flow duration and neurologically intact survival in patients with an initial shockable rhythm after OHCA. Methods We reviewed 82,464 patients with OHCA (aged ≥18 years, non-traumatic, witnessed, and without any bystander interventions) who were included in the All-Japan Utstein-style registry from 2013 to 2017. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). No-flow duration was defined as the time from emergency call to emergency medical services (EMS) arrival at the patient site. Results The rate of 1-month neurologically intact survival in the patients with an initial shockable rhythm (n = 10,384, 12.6% of overall patients) was 16.5% (1718/10,384). No-flow duration was significantly and inversely associated with 1-month neurologically intact survival (adjusted odds ratios for 1-minute increments: 0.85, 95% confidence interval: 0.84–0.86). The proportion of patients with a shockable rhythm to the overall patients (y, %) had a high correlational relationship with no-flow duration (x, min), depicted by y = 21.0 - 0.95 × x, R² = 0.935. In this analytical model, the number of patients with shockable rhythm reached null at 22 minutes of no-flow duration. The no-flow durations, beyond which the chance for initial shockable rhythm diminished to &lt;10%, &lt;5%, and &lt;1%, were 12, 13, and 17 minutes, respectively. The rate of neurologically intact survival in the patients with shockable rhythm (y, %) and no-flow duration (x, min) were also found to have a strong correlation, depicted by y = 0.16 × x² - 5.12 × x + 45.0, R² = 0.907. The no-flow durations, beyond which the chance for 1-month neurologically intact survival diminished to &lt;10%, &lt;5%, and &lt;1%, were 10, 11, and 15 minutes, respectively. Conclusions In OHCA patients without any bystander interventions before EMS personnel arrival, when a shockable rhythm is recorded by EMS personnel as an initial rhythm, the no-flow duration after cardiac arrest is highly likely to be &lt;17 minutes regardless of the layperson witness status. The limitation of no-flow duration to obtain a 1-month neurologically intact survival after OHCA may be 15 minutes when the patients have an initial shockable rhythm.

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