scholarly journals LO74: Prehospital sodium bicarbonate use was associated with worse neurological outcomes among patients with out-of-hospital non-traumatic cardiac arrest

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S53
Author(s):  
T. Kawano ◽  
F.X. Scheuermeyer ◽  
J. Christenson ◽  
R. Stenstrom ◽  
B.E. Grunau
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Sodium Bicarbonate ◽  
Treated Group ◽  
Population Based ◽  
Lower Probability ◽  
Crude Odds Ratio ◽  
Neurological Outcomes ◽  
Traumatic Cardiac Arrest ◽  
Favorable Neurological Outcome

Introduction: Sodium bicarbonate (SB) is still widely used for resuscitation in out-of- hospital cardiac arrest (OHCA) despite limited clinical indications but the effect on neurological recovery is unclear. Methods: From 2006 to 2016, we prospectively conducted a province-wide population-based observational study of adult non-traumatic OHCA patients managed by EMS. According to provincial guidelines, paramedics administered SB to OHCA patients based on their clinical assessment. Outcome of interest was favorable neurological outcome at hospital discharge, defined as CPC of 1 and 2 or modified Rankin scale of 3 or less. We performed multivariable logistic regression, comparing the proportion of outcome between SB and non-SB groups, further stratified by the median of the length of resuscitation. We also applied propensity score matching technique adjusting for baseline characters to the same model to reduce potential selection bias. Results: Of 13,008 OHCA patients, 4,699 (36.1%) were managed with SB. In the SB treated group, 64 / 4,699 (1.3%) patients had favorable neurological outcomes, compared to 823 / 8,309 (9.9%) in the non-SB treated group (crude odds ratio [OR] 0.12, 95% CI 0.09 to 0.16). In logistic regression model, SB was associated with decreased probability of favorable outcomes (adjusted OR 0.63, 95% CI 0.45 to 0.89). Similarly, with stratification by length of resuscitation, the SB group had a lower probability of favorable outcomes (≦24 min: adjusted OR 0.68, 95% CI 0.46 to 1.02, >24 min: adjusted OR 0.47, 95% CI 0.23 to 0.97). In 1:1 propensity matched cohort including 5,126 OHCA patients, the adjusted association also persisted (adjusted OR 0.59, 95% CI 0.39 to 0.89). Conclusion: Prehospital administration of SB to OHCA patients was associated with worse neurological outcomes and the trend persisted even after stratification by resuscitation length.

scholarly journals P069: Prehospital amiodarone use could improve favorable neurological recovery among patients with out-of-hospital shockable cardiac arrest

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S101-S102
Author(s):  
T. Kawano ◽  
F.X. Scheuermeyer ◽  
J. Christenson ◽  
R. Stenstrom ◽  
B.E. Grunau
Keyword(s):  
Logistic Regression ◽  
Treated Group ◽  
Population Based ◽  
Neurological Recovery ◽  
Crude Odds Ratio ◽  
Neurological Outcomes ◽  
Electrical Defibrillation ◽  
Favorable Neurological Outcome ◽  
Adjusted Association ◽  
Wide Population

Introduction: Amiodarone may be used for shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), but the effect of prehospital use upon neurological outcomes still unclear. Methods: A prospective province-wide, population based observational study was conducted from January 2006 to March 2016. Adult emergency medical service-treated non-traumatic OHCA patients who received at least one electric defibrillation were included. Amiodarone was administered to patients with VF/ pVT by paramedics based on their clinical assessment, according to provincial guidelines. The outcome of interest was favorable neurological outcomes to hospital discharge, defined as modified Rankin scale of 3 or less. Multivariable logistic regression was performed to compare the proportion of patients with the primary outcome between amiodarone and non-amiodarone groups, further stratified by the number of electrical defibrillation. In addition, to mitigate the potential selection bias, the same logistic regression was conducted in 1:1 propensity score matched groups adjusting for baseline covariates. Results: Of 3,374 overall OHCA patients, 915 (27.1%) were managed with amiodarone. In the amiodarone group, 150 / 915 (16.4 %) patients had a favorable neurological outcome, compared to 455/2,459 (18.5%) in the non-amiodarone group (crude odds ratio [OR] 0.86, 95% CI 0.71 to 1.06). In the multiple logistic regression model, prehospital amiodarone was associated with increased probability of favorable neurological outcomes (adjusted OR 2.11, 95% CI 1.46 to 3.05). With stratification by the number of electrical defibrillation performed, amiodarone treated group showed higher probability of favorable neurological outcomes (1 or 2: adjusted OR 2.71, 95% CI 1.33 to 5.50, 3 and more: adjusted OR 1.67, 95% CI 0.99 to 2.39). Similarly, in 1:1 propensity matched cohort including 882 OHCA patients, the adjusted association persisted (adjusted OR 2.14, 95% CI 1.33 to 3.44). Conclusion: Prehospital administration of amiodarone to non-traumatic OHCA patients was associated with better neurological recovery, especially in those who received fewer electrical defibrillations.

Abstract 10436: The Association of Time to First Epinephrine Administration With Neurological Outcomes in Out of hospital Cardiac Arrest in Japan: Sos-kanto 2012 Study Report

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yosuke Homma ◽  
Hiraku Funakoshi ◽  
Takashi Shiga ◽  
Dai Miyazaki ◽  
Naohiro Yonemoto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Clinical Effectiveness ◽  
Multivariate Logistic Regression ◽  
Epinephrine Administration ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Mean Time

Introduction: The clinical effectiveness of the timing of first epinephrine administration (EA) including prehospital setting has not been established, especially in regards to neurological outcomes in patients subsequently receiving intensive care after admission. Study Objectives: The aim of this study was to evaluate the effectiveness of time to first EA on neurological outcomes following OHCA. Methods: This was a multicenter retrospective cohort study in Japan from January 2012 to March 2013. We used data from the Survey of Survivors after Cardiac Arrest in the Kanto Area in 2012 (SOS-KANTO 2012) database. All adult patients who were registered in this database and were administered epinephrine were included; unwitnessed OHCA and initial asystolic rhythms were excluded. Collected variables included age, gender, activities of daily living, witnessed status, bystander CPR, first documented rhythm, cause, and intensive care after admission. Multivariate logistic regression was performed to investigate the association between time to first EA and 1) ROSC, 2) 1-month survival, and 3) 1-month favorable neurological outcome. Results: Of 16,452 OHCAs, 5,281 met the inclusion criteria (male, 63.1%; mean age, 71.5 years). Mean time between call to first EA is 33.7min. 1,501patients (28.4%) had ROSC. Multivariate logistic regression showed that the earlier the EA, the better chance of ROSC if initial documented rhythm was both VF/VT (adjusted odds ratio [OR] for one minute delay, 0.98; 95% confidence interval [CI], 0.97-0.99) and Asystole/PEA (adjusted OR, 0.97; 95%CI, 0.97-0.98). In contrast, the earlier the EA, the better chance of 1-month survival if initial documented rhythm was only Asystole/PEA (adjusted OR, 0.95; 95%CI, 0.93-0.98). There were no significant differences between early EA and good neurological outcomes (VF/VT, 1.01 [95% CI, 0.97-1.04] and Asystole/PEA, 1.01 [95% CI, 0.96-1.05]). Conclusions: If initial documented rhythm was VF/VT, early EA was associated with increased chance of only ROSC. In contrast, early EA was associated with increased chance of ROSC and 1 month survival if initial documented rhythm was Asystole/PEA. Time to first EA was not associated with good neurological outcomes in any initial documented rhythm.

Abstract 340: Effect of the 2015 CPR Guidelines for Patients With Out-Of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm: Results From the All-Japan Utstein Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Eizo Tachibana ◽  
Naohiro Yonemoto ◽  
Yoshio Tahara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Population Based ◽  
Inclusion Criteria ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Favorable Neurological Outcome ◽  
Population Based Registry ◽  
Hospital Cardiac Arrest

Background: The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm, PEA and asystole, as an initial rhythm. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G), and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Results: The 109,175 patients who met the inclusion criteria comprised 18,764 who received CPR based on 2015G and 90,411 who received CPR based on 2010G. The figure showed favorable neurological outcomes at 30 days in the two groups. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in 2015G patients as compared to 2010G patients was 1.28 (95%CI 1.11-1.46, p<0.001). Conclusion: In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.

scholarly journals Benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-based, observational study in Niigata, Japan

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032967 ◽  
Author(s):  
Nobuhiro Sato ◽  
Tasuku Matsuyama ◽  
Kohei Akazawa ◽  
Kyoko Nakazawa ◽  
Yasuo Hirose
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Population Based ◽  
Secondary Outcome ◽  
Community Based ◽  
Neurological Outcomes ◽  
Urban City ◽  
Hospital Cardiac Arrest

ObjectiveThis study aimed to assess the benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest using a community-based registry.DesignPopulation-based, retrospective cohort study.SettingAn urban city with approximately 800 000 residents.ParticipantsPatients aged ≥18 years with bystander-witnessed out-of-hospital cardiac arrests of medical aetiology in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style.Primary and secondary outcome measuresThe primary outcome was 1-month survival with a favourable neurological outcome, defined as a cerebral performance category score of 1 or 2. We used logistic regression analysis to assess the association between favourable neurological outcome and prehospital physician involvement.ResultsDuring the study period, a total of 4172 cardiac arrests were registered; of these, 892 patients with out-of-hospital cardiac arrest were eligible for this analysis, among whom 135 (15.1%) had prehospital physician involvement and 757 (84.9%) did not have prehospital physician involvement. The percentage of favourable neurological outcomes was 20.7% (28 of 135) in those with physician involvement and 10.4% (79 of 757) in those without physician involvement (p=0.001). Using multivariable logistic regression, prehospital physician involvement had an OR for a favourable neurological outcome of 3.44 (95% CI 1.64 to 7.23).ConclusionsAmong adults with out-of-hospital cardiac arrest, adding a physician-staffed ambulance was associated with significantly greater favourable neurological outcomes than standard emergency medical services.

Abstract 199: Pulmonary Embolism and Accidental Hypothermia Have a Favorable Outcome in Cardiac Arrest With PEA Treated by ECPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shinichi Ijuin ◽  
Akihiko Inoue ◽  
Nobuaki Igarashi ◽  
Shigenari Matsuyama ◽  
Tetsunori Kawase ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Accidental Hypothermia ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Group B ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also not significantly different (Group G; 46.1 ± 20.2 min vs Group B; 46.8 ± 21.7 min, p=0.92). Ten patients achieved favorable neurological outcome among 39 (26%) with non-cardiac etiology. In cardiac etiology, only 3 of 29 patients (9%) had a good outcome at 1 month (p=0.08). In particular, 5 patients of 10 pulmonary embolism, and 4 of 4 accidental hypothermia responded well to ECPR with a favorable neurological outcome. Additionally, 6 of 13 (46%), who had in hospital cardiac arrest, had good outcome, whereas 7 of 55 (15%) who had out of hospital cardiac arrest, had good outcome (p=0.02). Conclusions: In our small cohort of cardiac arrest patients with pulmonary embolism or accidental hypothermia and PEA with witness, EPCR contributed to favorable neurological outcomes at 1 month.

Effects of Targeted Temperature Management in Patients with Post-Cardiac Arrest Syndrome after an Out-Of-Hospital Cardiac Arrest Caused by Hanging: A Prospective Observational Cohort Study in Japan

2021 ◽  
Author(s):  
Ryuichiro Kakizaki ◽  
Naofumi Bunya ◽  
Shuji Uemura ◽  
Takehiko Kasai ◽  
Keigo Sawamoto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Propensity Score ◽  
Multivariate Logistic Regression Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Matched Cohort ◽  
Neurological Outcomes ◽  
Post Cardiac Arrest Syndrome ◽  
Hospital Cardiac Arrest

Abstract Background: Targeted temperature management (TTM) is recommended for unconscious patients after a cardiac arrest. However, its effectiveness in patients with post-cardiac arrest syndrome (PCAS) by hanging remains unclear. Therefore, this study aimed to investigate the relationship between TTM and favorable neurological outcomes in patients with PCAS by hanging.Methods: This study was a retrospective analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest (OHCA) registry between June 2014 and December 2017 among patients with PCAS admitted to the hospitals after an OHCA caused by hanging. A multivariate logistic regression analysis was performed to estimate the propensity score and to predict whether patients with PCAS by hanging receive TTM. We compared patients with PCAS by hanging who received TTM (TTM group) and those who did not (non-TTM group) using propensity score analysis.Results: A total of 199 patients with PCAS by hanging were enrolled in this study. Among them, 43 were assigned to the TTM group and 156 to the non-TTM group. Logistic regression model adjusted for propensity score revealed that TTM was not associated with favorable neurological outcome at 1-month (adjusted odds ratio [OR]: 1.38, 95% confidence interval [CI]: 0.27–6.96). Moreover, no difference was observed in the propensity score-matched cohort (adjusted OR: 0, 73, 95% CI: 0.10–4.71) and in the inverse probability of treatment weighting-matched cohort (adjusted OR: 0.63, 95% CI: 0.15–2.69).Conclusions: TTM was not associated with increased favorable neurological outcomes at 1-month in patients with PCAS after OHCA by hanging.

scholarly journals Prehospital cardiopulmonary resuscitation duration and neurological outcome after adult out-of-hospital cardiac arrest by location of arrest

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S90-S99
Author(s):  
Takefumi Kishimori ◽  
Tasuku Matsuyama ◽  
Kosuke Kiyohara ◽  
Tetsuhisa Kitamura ◽  
Haruka Shida ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Regression Analyses ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Background Little is known about the association between prehospital cardiopulmonary resuscitation duration for adults with out-of-hospital cardiac arrest and outcome by the location of arrests. This study aimed to investigate the association between prehospital cardiopulmonary resuscitation duration and one-month survival with favourable neurological outcome. Methods We analysed 276,391 adults aged 18 years and older with out-of-hospital cardiac arrest of medical origin before emergency medical service arrival. Prehospital cardiopulmonary resuscitation duration was defined as the time from emergency medical service-initiated cardiopulmonary resuscitation to prehospital return of spontaneous circulation or to hospital arrival. The primary outcome was one-month survival with favourable neurological outcome (cerebral performance category 1 or 2). The association between prehospital cardiopulmonary resuscitation duration and favourable neurological outcome was assessed using univariable and multivariable logistic regression analyses. Results The proportion of favourable neurological outcomes was 2.3% in total, 7.6% in public locations, 1.5% in residential locations and 0.7% in nursing homes ( P < 0.001). In univariable and multivariable logistic regression analyses, longer prehospital cardiopulmonary resuscitation duration was associated with poor neurological outcome, regardless of arrest location ( P for trend < 0.001). Patients with shockable rhythm in both public and residential locations had better neurological outcome than those in nursing homes at any time point, and residential and public locations had a similar neurological outcome tendency among patients with shockable rhythm. Conclusions Longer prehospital cardiopulmonary resuscitation duration was independently associated with a lower proportion of patients with favourable neurological outcomes. Moreover, the association between prehospital cardiopulmonary resuscitation duration and neurological outcome differed according to the location of arrest and the first documented rhythm.

scholarly journals Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
SungJoon Park ◽  
Sung Woo Lee ◽  
Kap Su Han ◽  
Eui Jung Lee ◽  
Dong-Hyun Jang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Patient Characteristics ◽  
Related Factors ◽  
Neurological Outcomes ◽  
Upper Limit ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Off Time

Abstract Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration.

scholarly journals Shortening of low-flow duration over time was associated with improved outcomes of extracorporeal cardiopulmonary resuscitation in in-hospital cardiac arrest

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Akiko Higashi ◽  
Taka-aki Nakada ◽  
Taro Imaeda ◽  
Ryuzo Abe ◽  
Koichiro Shinozaki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Quality Improvement ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Flow Duration ◽  
Over Time

Abstract Introduction Quality improvement in the administration of extracorporeal cardiopulmonary resuscitation (ECPR) over time and its association with low-flow duration (LFD) and outcomes of cardiac arrest (CA) have been insufficiently investigated. In this study, we hypothesized that quality improvement in efforts to shorten the duration of initiating ECPR had decreased LFD over the last 15 years of experience at an academic tertiary care hospital, which in turn improved the outcomes of in-hospital CA (IHCA). Methods This was a single-center retrospective observational study of ECPR patients between January 2003 and December 2017. A rapid response system (RRS) and an extracorporeal membrane oxygenation (ECMO) program were initiated in 2011 and 2013. First, the association of LFD per minute with the 90-day mortality and neurological outcome was analyzed using multiple logistic regression analysis. Then, the temporal changes in LFD were investigated. Results Of 175 study subjects who received ECPR, 117 had IHCA. In the multivariate logistic regression, IHCA patients with shorter LFD experienced significantly increased 90-day survival and favorable neurological outcomes (LFD per minute, 90-day survival: odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.94–1.00, P = 0.032; 90-day favorable neurological outcome: OR = 0.97, 95% CI = 0.94–1.00, P = 0.049). In the study period, LFD significantly decreased over time (slope − 5.39 [min/3 years], P < 0.0001). Conclusion A shorter LFD was associated with increased 90-day survival and favorable neurological outcomes of IHCA patients who received ECPR. The quality improvement in administering ECPR over time, including the RRS program and the ECMO program, appeared to ameliorate clinical outcomes.

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