scholarly journals Impact of audiovisual feedback in resuscitation on return of spontaneous circulation and survival

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
LER Obling ◽  
C Hassager ◽  
SNF Blomberg ◽  
F Folke
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Admission ◽  
Real Life ◽  
Spontaneous Circulation ◽  
Chi Square ◽  
Feedback Group ◽  
Return Of Spontaneous Circulation ◽  
Logistic Regression Models

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Treatment with an automated external defibrillator (AED) and cardiopulmonary resuscitation (CPR) are important factors for outcome in out-of-hospital cardiac arrest (OHCA). Audiovisual (AV) feedback from an AED may improve quality of cardiopulmonary resuscitation (CPR). However, the association between AV feedback in resuscitation and clinical outcomes is not well assessed in real-life OHCA. PURPOSE We sought to assess the association between AV feedback from an AED with rates of return of spontaneous circulation (ROSC) and 30-day survival in a real-life cohort of OHCA patients. METHODS We included 325 patients treated with an AED in the time period 2016-2019 from the Capital Region of Denmark. AED ECG data was analyzed before merging with data from the Danish Cardiac Arrest Register. Patients were divided into a "feedback" and a "non-feedback" group, depending on the presence of AV feedback in the AED applied before arrival of the Emergency Medical Services. Rates of ROSC upon admission and 30-day survival were compared between groups using the chi-square test. Further, uni- and multivariate logistic regression models were applied to assess the association between AV feedback and ROSC along with survival. Multivariate models were adjusted for sex, age, primary ECG rhythm and location of OHCA. RESULTS A total of 155 (47.7%) patients had an AED applied with AV feedback and 170 (52.3%) without AV feedback. There was no difference in Utstein characteristics between groups. Overall ROSC at hospital admission and 30-day survival was 39.1% (n = 127) and 29.2% (n = 95). While there was no difference in 30-day survival between feedback groups (p = 0.49), we found a decreased rate of ROSC at hospital admission for the feedback group compared to the non-feedback group, 32.9% (n = 51) versus 44.7% (n = 76), (p = 0.03), respectively (Figure 1). In the univariate logistic regression analysis, the feedback group showed a decreased chance of ROSC (OR 0.61, 95%CI 0.38-0.95, p = 0.03), which remained significant even after adjustment in the multivariate model (OR 0.54, 95%CI 0.33-0.86, p = 0.01). There was no significant association with 30-day survival in uni- and multivariate analyses with an OR of 0.82 (95%CI 0.51-1.32, p = 0.42) and OR 0.90 (95%CI 0.49-1.67, p = 0.74), respectively. CONCLUSION We found an association of decreased rates of ROSC at hospital admission, though no association with 30-day survival, when comparing use of AEDs with and without AV feedback in real-life OHCA patients. Abstract Figure. ROSC and 30-day survival

scholarly journals Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tiffany S. Ko ◽  
Constantine D. Mavroudis ◽  
Ryan W. Morgan ◽  
Wesley B. Baker ◽  
Alexandra M. Marquez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hemoglobin Concentration ◽  
Spontaneous Circulation ◽  
Youden Index ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Non Invasive ◽  
Tissue Optical Properties ◽  
Tenfold Cross Validation

AbstractNeurologic injury is a leading cause of morbidity and mortality following pediatric cardiac arrest. In this study, we assess the feasibility of quantitative, non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) neuromonitoring during cardiopulmonary resuscitation (CPR), and its predictive utility for return of spontaneous circulation (ROSC) in an established pediatric swine model of cardiac arrest. Cerebral tissue optical properties, oxy- and deoxy-hemoglobin concentration ([HbO2], [Hb]), oxygen saturation (StO2) and total hemoglobin concentration (THC) were measured by a FD-DOS probe placed on the forehead in 1-month-old swine (8–11 kg; n = 52) during seven minutes of asphyxiation followed by twenty minutes of CPR. ROSC prediction and time-dependent performance of prediction throughout early CPR (< 10 min), were assessed by the weighted Youden index (Jw, w = 0.1) with tenfold cross-validation. FD-DOS CPR data was successfully acquired in 48/52 animals; 37/48 achieved ROSC. Changes in scattering coefficient (785 nm), [HbO2], StO2 and THC from baseline were significantly different in ROSC versus No-ROSC subjects (p < 0.01) after 10 min of CPR. Change in [HbO2] of + 1.3 µmol/L from 1-min of CPR achieved the highest weighted Youden index (0.96) for ROSC prediction. We demonstrate feasibility of quantitative, non-invasive FD-DOS neuromonitoring, and stable, specific, early ROSC prediction from the third minute of CPR.

Abstract 324: Assessment in Therapeutic Hypothermia Protocol: A Quality Assessment Initiative and Analysis of Hemodynamic and Laboratory Parameters

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ediz Tasan ◽  
Alison Bailey ◽  
Charles Campbell
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Spontaneous Circulation ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Laboratory Parameters ◽  
Logistic Regression Models ◽  
Discharge Disposition ◽  
Home Discharge

Background: Therapeutic hypothermia (TH) is often considered for comatose patients with return of spontaneous circulation after cardiac arrest (CA). While patients undergoing out-of-hospital ventricular fibrillation cardiac arrest are thought to benefit most from TH, the individualized benefit of initiating TH is unknown. Using a combination of clinical and laboratory parameters at presentation, we sought a model to predict survival and discharge to home. Methods: We performed a retrospective study of patients undergoing TH after CA at the University of Kentucky Hospital from 4/1/11 to 12/31/13. Records confirmed by chart review. The primary outcomes were discharge disposition and death. We conducted logistic regression analyses to identify predictors of home discharge and survival. Results: The series included 80 patients (mean±SD age was 55.2±14.9, and 61% were male). The overall mortality rate was 67.9% with survivor home discharge disposition of 21.2%. The Apache II Score (estimated odds ratio [OR] 1.167) was a significant predictor of death; moreover, though not itself a significant predictor of death, troponin improved the ability of Apache II to predict death. The Apache II Score (OR 0.882) and Mean Arterial Pressure (OR 1.049) were significant predictors of home discharge. Figures 1 and 2 display estimated probabilities of survival and home discharge based on two-predictor logistic regression models. Conclusions: In patients undergoing TH, a favorable prognosis is anticipated given certain values for hemodynamic and laboratory parameters. Thus, the patient’s clinical presentation may provide additional guidance when considering initiation of TH after CA.

Abstract 349: Target Temperature Management After Return of Spontaneous Circulation Did Not Ameliorate Mid-term (30 to 90-day) Neurological Improvement in Out-of-hospital Cardiac Arrest Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Hiromichi Naito ◽  
Takashi Yorifuji ◽  
Tetsuya Yumoto ◽  
Tsuyoshi Nojima ◽  
Noritomo Fujisaki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Regression Analysis ◽  
Spontaneous Circulation ◽  
Temperature Management ◽  
Multivariable Logistic Regression Analysis ◽  
Return Of Spontaneous Circulation ◽  
Neurological Improvement ◽  
Hospital Cardiac Arrest

Introduction: Mid/long-term outcomes of out-of-hospital cardiac arrest (OHCA) survivors have not been extensively studied. Targeted temperature management (TTM) after return of spontaneous circulation is one known therapeutic approach to ameliorate short-term neurological improvement of OHCA patients; however, the prognostic significance of TTM in the mid/long-term clinical setting have not been defined. Hypothesis: TTM would confer additional improvement of OHCA patients’ mid-term neurological outcomes. Methods: Retrospective study using the Japanese Association for Acute Medicine OHCA Registry (Jun 2014 - Dec 2017): a nationwide multicenter registry. Patients who did not survive 30 days after OHCA, those with missing 30-day Cerebral Performance Category (CPC) scores, and those < 18 years old were excluded. Primary endpoint was alteration of neurological function evaluated with 30-day and 90-day CPC. Association between application of TTM (33-36°C) and mid-term CPC alteration was evaluated. Multivariable logistic regression analysis was used for the primary outcome; results are expressed with odds ratio (OR) and 95% confidence interval (CI). Results: We included 2,905 in the analysis. Patient characteristics were: age: 67 [57 - 78] years old, male gender: 70.8%, witnessed collapse: 81.4%, dispatcher instruction for CPR: 51.6%, initial shockable rhythm: 67.0%, and estimated cardiac origin: 76.5%. TTM was applied to 1,352/2,905 (46.5%) patients. Thirty-day CPC values in surviving patients were: CPC 1: 1,155/2,905 (39.8%), CPC 2: 321/2,905 (11.1%), CPC 3: 497/2,905 (17.1%), and CPC 4: 932/2,905 (32.1%), respectively. Ninety-day CPC values were: CPC 1: 866/1,868 (46.4%), CPC 2: 154/1,868 (8.2%), CPC 3: 224/1,868 (12.0%), CPC 4: 392/1,868 (20.1%), and CPC 5: 232/1,868 (12.4%), respectively. Of 1,636 patients with 90-day survival, 28 (1.7%) demonstrated improved CPC at 90 days, whereas, 133 (8.1%) showed worsened CPC at 90 days compared with 30-day CPC, respectively. Multivariable logistic regression analysis revealed TTM did not result in favorable mid-term neurological changes (adjusted OR: 1.44, 95% CI: 0.48 - 4.31). Conclusions: TTM may not contribute to the beneficial effect on OHCA patients’ mid-term neurological changes.

scholarly journals Older female relatives of Covid-19 patients have an unsatisfactory perception of emergency room performance by clinical staf

2021 ◽  
Vol 3 (2) ◽  
pp. 37-38
Author(s):  
Tiziana Ciarambino ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Cardiopulmonary Resuscitation ◽  
Adverse Reactions ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Cardiac Arrhythmia Suppression Trial ◽  
Supraventricular Tachyarrhythmias

Flecainide is a class I antiarrhythmic used for supraventricular tachyarrhythmias with mild adverse reactions. We present a case report in a 78-year-old male that came to the emergency department with atrial fibrillation and was subsequently treated with flecainide. During the infusion, the patient went into cardiac arrest. Cardiopulmonary resuscitation was performed until the return of spontaneous circulation was achieved after 1min and 40 seconds. Conclusion. Some trials, like The Cardiac Arrhythmia Suppression Trial (CAST), consider flecainide to be safe, but our case report, together with several other published reports brings attention to the use of flecainide in pharmacologic cardioversion of atrial fibrillation as a cause of cardiac arrest. Keywords: Older man, atrial fibrillation, emergency department, cardiac arrest, flecainide

scholarly journals Mechanical Versus Manual Chest Compression: A Retrospective-Cohort in Out-of-Hospital Cardiac Arrest

Acta Medica ◽  
2021 ◽  
pp. 1-7
Author(s):  
Alp Şener ◽  
Gül Pamukçu Günaydın ◽  
Fatih Tanrıverdi
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Retrospective Case ◽  
Return Of Spontaneous Circulation ◽  
Mechanical Chest Compression ◽  
Manual Chest Compression ◽  
Hospital Cardiac Arrest

Objective: In cardiac arrest cases, high quality cardiopulmonary resuscitation and effective chest compression are vital issues in improving survival with good neurological outcomes. In this study, we investigated the effect of mechanical chest compression devices on 30- day survival in out-of-hospital cardiac arrest. Materials and Methods: This retrospective case-control study was performed on patients who were over 18 years of age and admitted to the emergency department for cardiac arrest between January 1, 2016 and January 15, 2018. Manual chest compression was performed to the patients before January 15, 2017, and mechanical chest compression was performed after this date. Return of spontaneous circulation, hospital discharge, and 30-day survival rates were compared between the groups of patients in terms of chest compression type. In this study, the LUCAS-2 model piston-based mechanical chest compression device was used for mechanical chest compressions. Results: The rate of return of spontaneous circulation was significantly lower in the mechanical chest compression group (11.1% vs 33.1%; p < 0.001). The 30-day survival rate was higher in the manual chest compression group (6.8% vs 3.7%); however, this difference was not statistically significant (p = 0.542). Furthermore, 30-day survival was 0% in the trauma group and 0.6% in the patient group who underwent cardiopulmonary resuscitation for over 20 minutes. Conclusion: It can be seen that the effect of mechanical chest compression on survival is controversial; studies on this issue should continue and, furthermore, studies on the contribution of mechanical chest compression on labor loss should be conducted.

scholarly journals The Association of Extreme Tachycardia and Sustained Return of Spontaneous Circulation after Nontraumatic Out-of-Hospital Cardiac Arrest

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Dong Keon Lee ◽  
Eugi Jung ◽  
You Hwan Jo ◽  
Joonghee Kim ◽  
Jae Hyuk Lee ◽  
...  
Keyword(s):  
Heart Rate ◽  
Logistic Regression ◽  
Cardiac Arrest ◽  
Regression Model ◽  
Vital Sign ◽  
High Probability ◽  
Logistic Regression Model ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Objective. Heart rate (HR), an essential vital sign that reflects hemodynamic stability, is influenced by myocardial oxygen demand, coronary blood flow, and myocardial performance. HR at the time of the return of spontaneous circulation (ROSC) could be influenced by the β1-adrenergic effect of the epinephrine administered during cardiopulmonary resuscitation (CPR), and its effect could be decreased in patients who have the failing heart. We aimed to investigate the association between HR at the time of ROSC and the outcomes of adult out-of-hospital cardiac arrest (OHCA) patients. Methods. This study was a secondary analysis of a cardiac arrest registry from a single institution from January 2008 to July 2014. The OHCA patients who achieved ROSC at the emergency department (ED) were included, and HR was retrieved from an electrocardiogram or vital sign at the time of ROSC. The patients were categorized into four groups according to the HR (bradycardia (HR < 60), normal HR (60 ≤ HR ≤ 100), tachycardia (100 < HR < 150), and extreme tachycardia (HR ≥ 150)). The primary outcome was the rate of sustained ROSC and the secondary outcomes were the rate of one-month survival and six-month good neurologic outcome. Results. A total of 330 patients were included. In the univariate logistic regression model, the rate of sustained ROSC increased by 17% as HR increased by every 10 beats per minute (bpm) (odds ratio (OR), 1.171; 95% confidence interval (CI), 1.077–1.274, p<0.001). In the multivariate logistic regression model, extreme tachycardia was independently associated with a high probability of sustained ROSC compared to normal heart rate (OR, 15.96; 95% CI, 2.04–124.93, p=0.008). Conclusion. Extreme tachycardia (HR ≥ 150) at the time of ROSC is independently associated with a high probability of sustained ROSC in nontraumatic adult OHCA patients.

scholarly journals The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Renata Maria de Oliveira Botelho ◽  
Cássia Regina Vancini Campanharo ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Meiry Fernanda Pinto Okuno ◽  
Aécio Flávio Teixeira de Góis ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Control Group ◽  
Case Group ◽  
Chi Square ◽  
Significant Difference ◽  
Service Data

ABSTRACT Objective: to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR). Method: case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05. Results: ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112). Conclusion: the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC.

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