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

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.

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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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Prevalence and outcomes of out-of-hospital cardiac arrest survivors with left main or triple vessel coronary diseases: A multi-center, retrospective cohort study

10.21203/rs.3.rs-133537/v1 ◽

2020 ◽

Author(s):

Youn-Jung Kim ◽

Duk-Woo Park ◽

Yong Hwan Kim ◽

Minwoo Choi ◽

Su Jin Kim ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Coronary Angiography ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Complete Revascularization ◽

Left Main ◽

The Impact ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Abstract Background While multivessel coronary artery disease (CAD) is frequently observed in out-of-hospital cardiac arrest (OHCA) survivors, little is known about the impact of revascularization strategy on outcomes. We aimed to evaluate the prevalence of left main or triple vessel CAD in comatose survivors of OHCA and assess their outcome based on the revascularization strategy. Methods This multicenter retrospective cohort study was conducted at 9 Korean tertiary care hospitals. Adult comatose OHCA survivors with left main or triple vessel CAD documented by immediate (≤ 2 hours) coronary angiography after return of spontaneous circulation between 2011 and 2019 were included. The primary outcome was neurologically intact survival at 1-month defined as survival with a Cerebral Performance Category score of 1–2. Results Among 727 OHCA patients with immediate coronary angiography, 150 (25.3%) with left main or triple vessel CAD were identified and categorized into complete (N = 32), incomplete (N = 78), and no immediate (N = 40) revascularization groups. The rate of neurologically intact survival at 1 month was significantly different among the groups (53.1%, 32.1%, and 22.5% for complete, incomplete, and no immediate revascularization groups, respectively; P = 0.021). After adjustment using the inverse probability of treatment weighting, complete revascularization was independently associated with neurologically intact survival at 1 month (odds ratio, 2.635; 95% confidence interval, 1.128–6.155; P = 0.012). Conclusions Left main or triple vessel CAD is not uncommon in comatose OHCA patients. The rate of neurologically intact survival at 1 month was 34.0%, and it was significantly greater in patients with complete revascularization than in patients with incomplete or no immediate revascularization. Further clinical trials will be needed to confirm the best revascularization strategy to improve outcomes in such critically ill patients.

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