scholarly journals LO07: Double sequential external defibrillation improves termination of ventricular fibrillation and return of spontaneous circulation in shock-refractory out-of- hospital cardiac arrest

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S9 ◽  
Author(s):  
S. Cheskes ◽  
A. Wudwud ◽  
L. Turner ◽  
S. Mcleod ◽  
J. Summers ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Standard Therapy ◽  
Controlled Trial ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Return Of Spontaneous Circulation ◽  
Traumatic Cardiac Arrest ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Despite significant advances in resuscitation efforts, there are some patients who remain in ventricular fibrillation (VF) after multiple shocks during out-of-hospital cardiac arrest (OHCA). Double sequential external defibrillation (DSED) has been proposed as a treatment option for patients in shock refractory VF. We sought to compare DSED to standard therapy with regards to VF termination and return of spontaneous circulation (ROSC) for patients presenting in shock refractory VF. Methods: We performed a retrospective review of all treated adult OHCA who presented in VF and received a minimum of three successive shocks over a two year period beginning on Jan 1, 2015 in four Canadian EMS agencies. Using ambulance call reports and defibrillator files, we compared VF termination (defined as the absence of VF at the rhythm check following defibrillation and 2 minutes of CPR) and VF termination into a perfusing rhythm with ROSC between patients who received standard therapy (CPR, defibrillation, epinephrine and antiarrhythmics) and those who received DSED (after on-line medical consultation) for shock refractory VF. Cases of traumatic cardiac arrest and those who presented in VF but terminated VF prior to 3 successive shocks were excluded. Results: Among 197 patients who met the study criteria for shock refractory VF, 161 (81.7%) patients received standard therapy and 36 (18.3%) received DSED. For the primary outcome, VF termination was significantly higher for DSED compared to standard therapy (63.9% vs 18.0%; Δ45.9%; 95% CI: 28.3 to 60.5). For the secondary outcome of VF termination into ROSC, DSED was associated with significantly higher ROSC compared to standard care (33.3% vs 13%; Δ20.3%; 95% CI:13.0 to 33.3). The median (IQR) number of failed standard shocks prior to DSED was 8 (6, 10). When DSED terminated VF, it did so with a single DSED shock in 69.6% of cases. Conclusion: Our observational findings suggest improved VF termination and ROSC are associated with DSED compared to standard therapy for shock refractory VF. An appropriately powered randomized controlled trial is required to assess the impact of DSED on patient-important outcomes.

Association of Arterial Oxygen Tension During In-Hospital Cardiac Arrest With Return of Spontaneous Circulation and Survival

2016 ◽  
Vol 33 (7) ◽  
pp. 407-414 ◽  
Author(s):  
Jignesh K. Patel ◽  
Elinor Schoenfeld ◽  
Puja B. Parikh ◽  
Sam Parnia
Keyword(s):  
Cardiac Arrest ◽  
Oxygen Tension ◽  
Arterial Oxygen Tension ◽  
Spontaneous Circulation ◽  
Arterial Oxygen ◽  
Secondary Outcome ◽  
Return Of Spontaneous Circulation ◽  
Arterial Blood ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background: Despite numerous advances in the delivery of resuscitative care, in-hospital cardiac arrest (IHCA) continues to be associated with high morbidity and mortality. We sought to study the impact of arterial oxygen tension (Pao2) on return of spontaneous circulation (ROSC) and survival to discharge in patients with IHCA. Methods: The study population included 255 consecutive patients who underwent advanced cardiac life support–guided resuscitation from January 2012 to December 2013 for IHCA at an academic tertiary medical center. Of these patients, 167 underwent arterial blood gas testing at the time of the arrest. Baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was survival to hospital discharge. Secondary outcome of interest was presence of ROSC. Results: Of the 167 patients studied, Pao2 categorization included the following: Pao2 < 60 mm Hg (n = 38), Pao2 of 60-92 mm Hg (n = 44), Pao2 of 93 to 159 mm Hg (n = 43), Pao2 of 160 to 299 mm Hg (n = 24), and Pao2 ≥ 300 mm Hg (n = 18). Patients with higher Pao2 levels during the time of cardiac arrest were noted to have higher rates of hypertension and chronic kidney disease. Clinical presentation of IHCA, in particular, the initial rhythm, location of IHCA, and duration of cardiopulmonary resuscitation, was similar in all groups. Patients with higher Pao2 levels had higher platelet count, higher arterial pH, and lower arterial carbon dioxide tension (Pco2). With respect to outcomes, patients with higher intra-arrest Pao2 levels had progressively higher rates of ROSC (58% vs 71% vs 72% vs 79% vs 100%, P = .021) and survival to discharge (16% vs 23% vs 30% vs 33% vs 56%, P = .031). In multivariate analysis, Pao2 ≥ 300 mm Hg was independently associated with higher survival to discharge (odds ratio 60.68; 95% confidence interval: 3.04-1210.28; P = .007; referent Pao2 < 60 mm Hg). Conclusion: Higher intra-arrest Pao2 is independently associated with higher rates of survival to discharge in adults with IHCA.

Abstract 11817: The Effect of Time to Treatment With Antiarrhythmic Drugs on Return of Spontaneous Circulation in Shock Refractory Out-of-Hospital Cardiac Arrest: A Secondary Analysis of the ALPS Randomized Controlled Trial

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mahbod Rahimi ◽  
Paul Dorian ◽  
Sheldon Cheskes ◽  
Gerald Lebovic ◽  
Steve Lin
Keyword(s):  
Cardiac Arrest ◽  
Drug Administration ◽  
Controlled Trial ◽  
Group Versus ◽  
Study Drug ◽  
Spontaneous Circulation ◽  
Study Drug Administration ◽  
Time To Treatment ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Purpose: The effects of amiodarone and lidocaine on the return of spontaneous circulation (ROSC), relative to time to treatment in out of hospital cardiac arrest (OHCA) patients is unknown. We conducted a post-hoc analysis of the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, Placebo (ROC ALPS) randomized trial examining the association of time to treatment with ROSC at emergency department (ED) arrival. Method: In the ROC ALPS trial, adults with non-traumatic OHCA with initial VF/pVT after ≥ 1 shock were randomized to receive amiodarone, lidocaine or placebo. We used logistic regression to examine the association of time to treatment (911 call to study drug administration interval) with ROSC at ED arrival. Results: Overall, 1112 (36.7%) patients had ROSC at ED arrival. Time to treatment data were available for 2994 (99%) of the patients. The proportion of patients with ROSC at ED arrival decreased as time to drug administration increased, in amiodarone (OR 0.92, 95% CI 0.90-0.94 per min increase), lidocaine (OR 0.95, 95% CI: 0.93-0.96) and placebo (OR 0.95, 95% CI: 0.93-0.96) arms. The odds of ROSC at ED in the amiodarone group (versus placebo) changed in relation to the time of drug administration (OR 0.96, 95% CI: 0.93-0.99). With short times to drug administration, ROSC was higher in amiodarone versus placebo recipients, whereas ROSC was higher with placebo at later times. Comparing lidocaine to placebo, ROSC rate increased at all times (OR 1.29, 95% CI: 1.07-1.59); there was no time to drug administration effect (OR 1.00, 95% CI: 0.97-1.03). Among all patients, survival at hospital discharge was 21.0%, 24.4%, and 23.7% for placebo, amiodarone and lidocaine respectively. Conclusion: Amiodarone’s efficacy in restoring ROSC declined with longer duration of arrest, potentially due to its adverse hemodynamic effects. Overall, amiodarone and lidocaine had similar effects on mortality; in this study, ROSC at ED arrival trend did not reflect the overall survival rate

Clinical case review: out-of-hospital cardiac arrest following thyroid storm

2021 ◽  
Vol 13 (4) ◽  
pp. 144-150
Author(s):  
Matthew Hale ◽  
Jo Mildenhall ◽  
Christopher Hook ◽  
James Burt
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Clinical Case ◽  
Spontaneous Circulation ◽  
Thyroid Storm ◽  
Case Review ◽  
Return Of Spontaneous Circulation ◽  
Good Outcome ◽  
Hospital Cardiac Arrest

Acute thyrotoxicosis (thyroid storm) caused by hyperthyroidism is a rare but severe endocrine imbalance which, in extreme cases, may lead to ventricular fibrillation and ultimately, without intervention, death. The authors attended such an incident and, following clinical interventions, achieved return of spontaneous circulation with a good outcome for the patient and subsequent hospital discharge.

scholarly journals Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

2021 ◽  
Author(s):  
Jun Wei Yeo ◽  
Zi Hui Celeste Ng ◽  
Amelia Xin Chun Goh ◽  
Jocelyn Fangjiao Gao ◽  
Nan Liu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Meta Analysis ◽  
High Volume ◽  
Spontaneous Circulation ◽  
Sensitivity Analyses ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Interhospital Transfer ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups. Methods and Results Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected. Conclusions Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.

scholarly journals Comparison of Dopamine and Norepinephrine Use for the Treatment of Hypotension in Out-Of-Hospital Cardiac Arrest Patients with Return of Spontaneous Circulation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Chao-Jui Li ◽  
Kuan-Han Wu ◽  
Chien-Chih Chen ◽  
Yat-Yin Law ◽  
Po-Chun Chuang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Study Groups ◽  
Therapeutic Agents ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
The Impact ◽  
Hospital Cardiac Arrest

In patients experiencing out-of-hospital cardiac arrest (OHCA), hypotension is common after return of spontaneous circulation (ROSC). Both dopamine and norepinephrine are recommended as inotropic therapeutic agents. This study aimed to determine the impact of the use of these two medications on hypotension. This is a multicenter retrospective cohort study. OHCA patients with ROSC were divided into three groups according to the post resuscitation inotropic agent used for treatment in the emergency department, namely, dopamine, norepinephrine, and dopamine and norepinephrine combined therapy. Thirty-day survival and favorable neurologic performance were analyzed among the three study groups. The 30-day survival and favorable neurologic performance rates in the three study groups were 12.5%, 13.0%, and 6.8% as well as 4.9%, 4.3%, and 1.2%, respectively. On controlling the potential confounding factors by logistic regression, there was no difference between dopamine and norepinephrine treatment in survival and neurologic performance (adjusted odds ratio (aOR): 1.0, 95% confidence interval (CI) 0.48–2.06; aOR: 0.8, 95% CI: 0.28–2.53). The dopamine and norepinephrine combined treatment group had worse outcome (aOR: 0.6, 95% CI: 0.35–1.18; aOR: 0.2, 95% CI: 0.05–0.89). In conclusion, there was no significant difference in post-ROSC hypotension treatment between dopamine and norepinephrine in 30-day survival and favorable neurologic performance rates.

Abstract 111: Impact of Time to Return of Spontaneous Circulation on Neurologically Intact Survival in Patients With Out-of-Hospital Cardiac Arrest According to Age: Evidence From a Large-Scale Registry in Japan

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Hayato Tada ◽  
Masaya Shimojima ◽  
Hirofumi Okada ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Large Scale ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Performance Category ◽  
Return Of Spontaneous Circulation ◽  
The Impact ◽  
The Relationship ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Introduction: Time to return of spontaneous circulation (ROSC) is a more important predictor of neurologically intact survival than the presence of ROSC in patients with out-of-hospital cardiac arrest (OHCA). However, the differences in the relationship between time to ROSC and neurologically intact survival in patients with OHCA based on age is unclear. Hypothesis: We hypothesized that the impact of time to ROSC on neurologically intact survival differs according to age. Methods: We analyzed the data of 34,905 patients with OHCA (age ≥18 years) who exhibited prehospital ROSC from the prospectively recorded all-Japan OHCA registry (2011-2014). The primary outcome was neurologically intact survival at 1 month after OHCA (cerebral performance category [CPC] 1 or 2). Time to ROSC was defined as the interval from the initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers to the achievement of ROSC. We categorized time to ROSC by every 4-min interval (2 cycles of CPR) from 1 to 32 min and ≥33 min, and age into 4 groups: 18-64, 65-74, 75-89, and ≥90 years. Results: The overall CPC 1-2 rate was 21.1% (7,353/34,905). Increasing time to ROSC (per min) was negatively associated with CPC 1-2 (adjusted odds ratio, 0.91; 95% confidence interval, 0.90-0.91). The CPC 1-2 rates decreased as time to ROSC increased in each age group: from 58.8% (1,247/2,122) in 1-4 min to 2.8% (7/246) in ≥33 min for patients aged 18-64 years, from 51.1% (721/1,410) in 1-4 min to 1.6% (4/244) in ≥33 min for 65-74 years, from 37.3% (765/2,051) in 1-4 min to 0.7% (4/539) in 29-32 min for 75-89 years, and from 23.4% (92/393) in 1-4 min to 0.2% (1/481) in 17-20 min for ≥90 years (all p for trend <0.001). Conclusions: The CPC 1-2 rates of patients aged 18-64 and 65-74 years were above the 1% futility rate when prehospital ROSC was achieved after prolonged CPR, ≥33 min from initiation by EMS providers. However, the CPC 1-2 rates were below the 1% futility rate when prehospital ROSC was achieved ≥29 min and ≥17 min for patients aged 75-89 years and ≥90 years, respectively.

scholarly journals Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore

2021 ◽  
Vol 18 (7) ◽  
pp. 3646
Author(s):  
Shir Lynn Lim ◽  
Nur Shahidah ◽  
Seyed Ehsan Saffari ◽  
Qin Xiang Ng ◽  
Andrew Fu Wah Ho ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Indirect Effects ◽  
Primary Outcome ◽  
Binary Logistic Regression ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Bystander Cpr ◽  
Civil Defence ◽  
The Impact ◽  
Hospital Cardiac Arrest

This study aimed to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) in Singapore. We used data from the Singapore Civil Defence Force to compare the incidence, characteristics and outcomes of all Emergency Medical Services (EMS)-attended adult OHCA during the pandemic (January–May 2020) and pre-pandemic (January–May 2018 and 2019) periods. Pre-hospital return of spontaneous circulation (ROSC) was the primary outcome. Binary logistic regression was used to calculate the adjusted odds ratios (aOR) for the characteristics of OHCA. Of the 3893 OHCA patients (median age 72 years, 63.7% males), 1400 occurred during the pandemic period and 2493 during the pre-pandemic period. Compared with the pre-pandemic period, OHCAs during the pandemic period more likely occurred at home (aOR: 1.48; 95% CI: 1.24–1.75) and were witnessed (aOR: 1.71; 95% CI: 1.49–1.97). They received less bystander CPR (aOR: 0.70; 95% CI: 0.61–0.81) despite 65% of witnessed arrests by a family member, and waited longer for EMS (OR ≥ 10 min: 1.71, 95% CI 1.46–2.00). Pre-hospital ROSC was less likely during the pandemic period (aOR: 0.67; 95% CI: 0.53–0.84). The pandemic saw increased OHCA incidence and worse outcomes in Singapore, likely indirect effects of COVID-19.

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