scholarly journals LO71: For patients suffering from out-of-hospital cardiac arrest, is survival influenced by the capabilities of the receiving hospital?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S52
Author(s):  
A. Cournoyer ◽  
E. Notebaert ◽  
L. De Montigny ◽  
M. Iseppon ◽  
S. Cossette ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
First Responders ◽  
Coronary Intervention ◽  
Spontaneous Circulation ◽  
Time Of Day ◽  
Absolute Difference ◽  
Supraglottic Airway ◽  
Multivariate Logistic Regression Model ◽  
Hospital Cardiac Arrest

Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) are frequently transported to the closest hospital after return of spontaneous circulation (ROSC). Percutaneous coronary intervention (PCI) is often indicated as a diagnostic and therapeutic procedure following OHCA. This study aimed to determine the association between the type of destination hospital (PCI-capable or not) and survival to discharge for patients with OHCA and prehospital ROSC. We hypothesized that being transported to a PCI-capable hospital would be associated with a higher survival to discharge. Methods: The present study used a registry of adult OHCA between 2010 and 2015 in Montréal, Canada. We included adult patients with non-traumatic OHCA and prehospital ROSC. The association of interest was evaluated with a multivariate logistic regression model to control for demographic and clinical variables (age, gender, time of day, initial rhythm, witnessed arrest, bystander CPR, presence of first responders or advanced care paramedics, prehospital supraglottic airway placement, delay before paramedics’ arrival). Assuming a survival rate of 40% and 75% of the variability explained by other factors included in the model, more than 1200 patients needed to be included to detect an absolute difference of 10% in survival between both groups with a power of more than 90%. Results: A total of 1691 patients (1140 men and 551 women) with a mean age of 64 years (standard deviation 17) were included, of which 1071 (63%) were transported to a PCI-capable hospital. Among all patients, 704 patients (42%) survived to hospital discharge. We observed a significant independent association between survival to discharge and being transported to a PCI-capable hospital (adjusted odds ratio [AOR] 1.46 [95% confidence interval 1.09-1.96]) after controlling for confounding variables. Having an initial shockable rhythm and presence of first responders also increased survival to discharge (AORs 3.67 [95% confidence interval 2.75-4.88] and 1.53 [95% confidence interval 1.12-2.09], respectively). Conclusion: Patients experiencing ROSC after OHCA could benefit from a direct transport to a PCI-capable hospital. This benefit might also be related to unmeasured interventions other than PCI these hospitals can provide (e.g. high-level intensive care or cardiovascular surgery).

Abstract 11372: A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Andy T Tran ◽  
Anthony Hart ◽  
John Spertus ◽  
Philip Jones ◽  
Bryan McNally ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Risk Adjustment ◽  
Quality Measures ◽  
Coronary Intervention ◽  
Spontaneous Circulation ◽  
Logistic Regression Models ◽  
Adjustment Model ◽  
Risk Adjustment Model ◽  
Hospital Cardiac Arrest

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

scholarly journals Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study

2019 ◽  
Vol 9 (6) ◽  
pp. 599-607 ◽  
Author(s):  
Grímur Høgnason Mohr ◽  
Kathrine B Søndergaard ◽  
Jannik L Pallisgaard ◽  
Sidsel Gamborg Møller ◽  
Mads Wissenberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Heart Rhythm ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest ◽  
Diabetes Patients

Background: Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. Methods: Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001–2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. Results: In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66–0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48–0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). Conclusion: No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.

scholarly journals Timing of inducing therapeutic hypothermia in patients successfully resuscitated after out-of-hospital cardiac arrest

2020 ◽  
pp. 102490792095856
Author(s):  
Doo Youp Kim ◽  
Jin Sup Park ◽  
Sun Hak Lee ◽  
Jeong Cheon Choe ◽  
Jin Hee Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Therapeutic Hypothermia ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Return Of Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background: Therapeutic hypothermia can improve neurological status in cardiac arrest survivors. Objectives: We investigated the association between the timing of inducing therapeutic hypothermia and neurological outcomes in patients who experienced out-of-hospital cardiac arrest. Methods: We evaluated data from 116 patients who were comatose after return of spontaneous circulation and those who received therapeutic hypothermia between January 2013 and April 2017. The primary endpoint was good neurological outcomes during index hospitalization, defined as a cerebral performance category score of 1 or 2. Therapeutic hypothermia timing was defined as the duration from the return of spontaneous circulation to hypothermia initiation. We analyzed the effect of early hypothermia induction on neurological results. Results: In total, 112 patients were enrolled. The median duration to hypothermia initiation was 284 min (25th–75th percentile, 171–418 min). Eighty-two (69.5%) patients underwent hypothermia within 6 h, and 30 (25.4%) had good neurological outcomes. The rates of good neurological outcomes by hypothermia initiation time quartile (shortest to longest) were 28.3%, 34.5%, 14.8%, and 28.6% (p = 0.401). The good neurologic outcomes did not differ between hypothermia patients within 6 h or after (26.5% vs 26.7%, p = 0.986). Short low-flow time and bystander resuscitation were associated with good neurological outcomes (p = 0.044, confidence interval: 0.027–0.955), but the timing of hypothermia initiation was not (p = 0.602, confidence interval: 0.622–1.317). Conclusion: A shorter low-flow time was associated with good neurological outcomes in out-of-hospital cardiac arrest patients who experienced hypothermia. However, inducing hypothermia sooner, even within 6 h, did not improve the neurological outcomes. Thus, as current guidelines recommend, initiating hypothermia within 6 h of recovery of spontaneous circulation is reasonable.

Abstract 2227: Results of Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction Patients Following Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Timothy D Henry ◽  
Sue Duval ◽  
Michael R Mooney ◽  
Katie M Menssen ◽  
Christopher E Kapsner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
Neurological Impairment ◽  
Spontaneous Circulation ◽  
Primary Pci ◽  
Anoxic Brain Injury ◽  
Major Predictor ◽  
Hospital Cardiac Arrest

Background: Patients with cardiac arrest associated with STEMI are routinely excluded from clinical trials and therefore, almost no data exist regarding their outcomes with primary PCI. Patients with out of hospital cardiac arrest (OOHCA) are a particularly high-risk cohort and the appropriate reperfusion strategy for these patients is controversial. Methods/Results: We determined the outcomes of patients who sustained a cardiac arrest prior to primary PCI in 1,500 consecutive patients with STEMI admitted to or transferred to a regional PCI center. Overall 159(10.6%) STEMI patients sustained a cardiac arrest prior to PCI, including 47 (3.1%) with OOHCA. The in-hospital, 30-day and 1-year mortality for patients without cardiac arrest, cardiac arrest excluding OOHCA and patients with OOHCA are included in table . 53.3% of the deaths in OOHCA were related to anoxic brain injury compared to 9.1% of the deaths in patients with in-hospital cardiac arrest (p<0.003). Thirty-six percent of patients with OOHCA underwent a cooling protocol (return of spontaneous circulation and persistent neurologic impairment) with a 41% in-hospital mortality. Conclusions: Cardiac arrest prior to PCI (including both OOHCA and in-hospital) in patients with STEMI is a major predictor for in-hospital mortality. Patients with cardiac arrest who survive to discharge subsequently do well. OOHCA has a higher mortality than in-hospital cardiac arrest and the majority of deaths are due to anoxic brain injury. Still, nearly 70% of OOHCA survived to discharge without neurological impairment.

Abstract 101: Top Quality of Ventilation During Out-of-Hospital Cardiac Arrest Is Hard to Reach

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Philip Datler ◽  
Patrick Sulzgruber ◽  
Michael Poppe ◽  
Markus Keferböck ◽  
Sebastian Zeiner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Ventilation Rate ◽  
Spontaneous Circulation ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Feedback Form ◽  
Hospital Cardiac Arrest

INTRODUCTION: With an incidence of ~45patients with out-of hospital cardiac arrest (OHCA) /100.000 inhabitants per year and thus over 700 cases annually, but a survival rate as low as 10%, OHCA remains still a challenge the chain of survival. Recently ventilation has gained less importance for BLS and thus the question arises, if this attitude was mirrored during ALS measures provided by ambulance crews. Therefore our analysis assessed the quality of ventilation during out of hospital cardiac arrests. METHODS: Over a period of 9 months, from August 1st 2013 until April 30th 2014, all patients suffering from an OHCA, aged 18 years and above and treated by the emergency medical service crews in Vienna, Austria were included in this study. A collective of 701 consecutive cases have been analyzed using the ECG- and impedance data recorded by the defibrillators used. On the basis of this data, the abidance of the quality standards of ventilation was examined using the current guidelines of the European Resuscitation Council of 2010 as gold standard. After the evaluation of each case, the responding EMS-teams were informed about the quality of the resuscitation via a feedback form. RESULTS: Endotracheal intubation was accomplished in 338 patients (47%). Ventilation was performed in accordance to the ERC guidelines in 49% (CI: 46-52) of total recorded ventilation minutes. Patients who had restoration of spontaneous circulation (ROSC) (n=135) after being intubated were ventilated with 9 (CI: 9-11; variance: 11) ventilations per minute. In patients not achieving ROSC (n=203) 10 (CI: 9-11; variance: 25) ventilations per minute were administered. Patients that were ventilated with a supraglottic airway device or a bag valve and mask received 6(SD±4) ventilations per minute. CONCLUSION: The high ventilation rate standard deviations within the compliance to guidelines suggest that there are numerous cases in which ventilation standards are not met. Therefore further analysis will be necessary to find out, what influence this might have on outcome and if it will be necessary to put more emphasis in upcoming discussions on the quality of ventilation at least during advanced life support.

Abstract 46: Meta-analysis of Endotracheal Intubation Versus Supraglottic Airway Placement by Emergency Medical Services During Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Justin L Benoit ◽  
Ryan B Gerecht ◽  
Michael T Steuerwald ◽  
Jason T McMullan
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Emergency Medical Services ◽  
Endotracheal Intubation ◽  
Odds Ratio ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Early Survival ◽  
Hospital Cardiac Arrest ◽  
Late Survival

Objective: Patients frequently undergo advanced airway management during out of hospital cardiac arrest (OHCA) resuscitation attempts. Recent observational data has associated endotracheal intubation (ETI) with worse outcomes and unacceptable failure rates. Supraglottic airways (SGA) are easier to insert, but the comparative effectiveness of this intervention is unclear. The objective of this study was to analyze all available data comparing patient outcomes for these two airway methods in OHCA patients treated by emergency medical services (EMS). Methods: A dual-reviewer search was conducted in PubMed, Embase, and the Cochrane Database with a research librarian to identify all relevant peer-reviewed articles. Exclusion criteria were traumatic arrests, pediatric patients, physician/nurse intubators, rapid sequence intubation, video devices, devices solely obstructing the esophagus, and studies using identical datasets. Outcomes were evaluated in two categories: (1) Early survival (return of spontaneous circulation or survival to hospital admission), and (2) Late survival (survival to discharge or neurologically intact survival). Results were summarized using odds ratios and combined using meta-analytic techniques, Cochran’s Q test, and the random effects model. Results: From 3,454 titles, we reviewed 325 abstracts, yielding 5 observational studies that fulfilled all criteria, with 60,635 ETI patients and 246,506 SGA patients. Important covariates such as age, gender, initial cardiac rhythm, witness status, and bystander CPR, were similar between patient groups in all studies. Significant study-level heterogeneity was present for both early survival (I2 = 87.3%, p < 0.001) and late survival (I2 = 66.1%, p = 0.001). Patients who received ETI had statistically significant higher odds of early survival (odds ratio 1.37, 95% confidence interval 1.04-1.81) but similar odds of late survival (odds ratio 1.17, 95% confidence interval 0.86-1.61) compared to SGA. Conclusion: Patients with OHCA treated by EMS are more likely to achieve return of spontaneous circulation or survive to admission after ETI compared to SGA, but this does not change ultimate survival. A randomized control trial is needed to further evaluate these associations.

scholarly journals TRENDS, PREDICTORS, AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION COMPLICATED BY IN-HOSPITAL CARDIAC ARREST

2021 ◽  
Vol 77 (18) ◽  
pp. 203
Author(s):  
Temidayo Abe ◽  
Titilope Olanipekun ◽  
Valery S. Effoe ◽  
Joseph Igwe ◽  
Obiora Egbuche ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Arrest ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Hospital Cardiac Arrest

scholarly journals Early lactate and glucose kinetics following return to spontaneous circulation after out-of-hospital cardiac arrest

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Pedro Freire Jorge ◽  
Rohan Boer ◽  
Rene A. Posma ◽  
Katharina C. Harms ◽  
Bart Hiemstra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Physiological Stress ◽  
Spontaneous Circulation ◽  
Strenuous Exercise ◽  
Rapid Rate ◽  
Glucose Kinetics ◽  
Initial Value ◽  
Extreme Stress ◽  
Arterial Ph ◽  
Hospital Cardiac Arrest

Abstract Objective Lactate has been shown to be preferentially metabolized in comparison to glucose after physiological stress, such as strenuous exercise. Derangements of lactate and glucose are common after out-of-hospital cardiac arrest (OHCA). Therefore, we hypothesized that lactate decreases faster than glucose after return-to-spontaneous-circulation (ROSC) after OHCA. Results We included 155 OHCA patients in our analysis. Within the first 8 h of presentation to the emergency department, 843 lactates and 1019 glucoses were available, respectively. Lactate decreased to 50% of its initial value within 1.5 h (95% CI [0.2–3.6 h]), while glucose halved within 5.6 h (95% CI [5.4–5.7 h]). Also, in the first 8 h after presentation lactate decreases more than glucose in relation to their initial values (lactate 72.6% vs glucose 52.1%). In patients with marked hyperlactatemia after OHCA, lactate decreased expediently while glucose recovered more slowly, whereas arterial pH recovered at a similar rapid rate as lactate. Hospital non-survivors (N = 82) had a slower recovery of lactate (P = 0.002) than survivors (N = 82). The preferential clearance of lactate underscores its role as a prime energy substrate, when available, during recovery from extreme stress.

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

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