scholarly journals Impact of the cardiopulmonary resuscitation-related injuries on the prognosis after cardiac arrest

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Merino Argos ◽  
I Marco Clement ◽  
S.O Rosillo Rodriguez ◽  
L Martin Polo ◽  
E Arbas Redondo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
University Hospital ◽  
Temperature Management ◽  
Performance Category ◽  
Neurological Outcomes ◽  
Cardiac Care Unit ◽  
Sternal Fractures

Abstract Background Cardiopulmonary resuscitation (CPR) manoeuvres involve vigorous compressions with the proper depth and rate in order to keep sufficient perfusion to organs, especially the brain. Accordingly, high incidences of CPR-related injuries (CPR-RI) have been observed in survivors after cardiac arrest (CA). Purpose To analyse whether CPR-related injuries have an impact on the survival and neurological outcomes of comatose survivors after CA. Methods Observational prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary university hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (TTM 32–34°) from August 2006 to December 2019. CPR-RI were diagnosed by reviewing medical records and analysing image studies during hospitalization. Results A total of 498 pts were included; mean age was 62.7±14.5 years and 393 (78.9%) were men. We found a total of 145 CPR-RI in 109 (21.9%) pts: 79 rib fractures, 20 sternal fractures, 5 hepatic, 5 gastrointestinal, 3 spleen, 1 kidney, 26 lung and 6 heart injuries. Demographic characteristics and cardiovascular risk factors did not differ between the non-CPR-RI group and CPR-RI group. Also, we did not find differences in CA features (Table 1). Survival at discharge was higher in the CPR-RI group [74 (67.8%) vs 188 (48.3%); p<0.001]. Moreover, Cerebral Performance Category (CPC) 1–2 within a 3-month follow-up was significantly higher in the CPR-RI group [(71 (65.1%) vs 168 (43.2%); p<0.001; Figure 1]. Finally, pts who recieved blood transfusions were proportionally higher in the CPR-RI group [34 (32.1%) vs 65 (16.7%)]; p=0.004). Conclusions In our cohort, the presence of CPR-RI was associated with higher survival at discharge and better neurological outcomes during follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital

2015 ◽  
Vol 13 (2) ◽  
pp. 183-188 ◽  
Author(s):  
Cássia Regina Vancini-Campanharo ◽  
Rodrigo Luiz Vancini ◽  
Claudio Andre Barbosa de Lira ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Meiry Fernanda Pinto Okuno ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Room ◽  
Cerebral Performance Category ◽  
Neurological Status ◽  
Performance Category ◽  
Emergency Room Patients ◽  
Initial Rhythm ◽  
One Year

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.

scholarly journals Mortality and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients With and Without Targeted Temperature Management in a Multiethnic Asian Population

2020 ◽  
Vol 49 (3) ◽  
pp. 127-136
Author(s):  
Wan Jing Tay ◽  
Huihua Li ◽  
Andrew FW Ho ◽  
Ching Hui Sia ◽  
Georgina GJ Kwek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Statistical Significance ◽  
Cerebral Performance Category ◽  
Asian Population ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Academic Medical Centre ◽  
Performance Category ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Introduction: The use of targeted temperature management (TTM) is increasing although adoption is still variable. We describe our 6-year experience and compare the mortality and neurological outcomes of out-of-hospital cardiac arrest (OHCA) patients with and without the use of TTM in a multiethnic Asian population. Materials and Methods: We performed a retrospective observational study at a tertiary academic medical centre. OHCA survivors admitted to our hospital between April 2010‒December 2016 were included. Outcomes of interest were 30-day mortality postresuscitation, Cerebral Performance Category (CPC) and Overall Performance Category (OPC) scores. Results: A total of 121 of 261 patients (46.3%) underwent TTM. TTM patients were younger (TTM 60.0 years old vs no TTM 63.7 years old, P = 0.047). There was no difference in the initial arrest rhythm of shockable origin between the 2 groups (P = 0.289). There was suggestion of lower 30-day mortality (TTM 24.3% vs no TTM 31.4%, P = 0.214), higher and good CPC/OPC scores (TTM 19.0% vs no TTM 15.7%, P = 0.514) with TTM although this did not reach statistical significance. On multivariable logistic regression analysis, TTM was not associated with 30-day mortality (P = 0.07). However, older age, initial non-shockable rhythm and increased duration from arrest to return of spontaneous circulation were associated with increased mortality. Malay ethnicity was associated with a poorer CPC/OPC score. Conclusion: Adoption and outcomes of TTM postresuscitation is variable and there is still a need to optimise management of the identified predictors of survival and good neurological outcomes while TTM is being used. Key words: Heart attack, Neurological function, Neuroprotection, Therapeutic hypothermia

Abstract 115: One-Year Outcomes in Individual Domains of the Cerebral Performance Category Extended

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Katharyn L Flickinger ◽  
Melissa J Repine ◽  
Stephany Jaramillo ◽  
Allison C Koller ◽  
Margo Holm ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Return To Work ◽  
Short Term Memory ◽  
Demographic Data ◽  
Cerebral Performance Category ◽  
Logical Thinking ◽  
Short Term ◽  
Performance Category ◽  
Term Memory

Introduction: Cognitive and physical impairments are common in cardiac arrest survivors. Global measures including the Modified Rankin Scale (mRS), Cerebral Performance Category (CPC) and the 10-domain CPC-Extended (CPC-E) tend to improve over 1 year. The CPC-E is scored from 1-5 with higher scores signifying greater impairment. However, with the CPC-E, individual functional domains (alertness, logical thinking, attention, motor skills, short-term memory, basic and complex activities of daily living (ADL), mood, fatigue, and return to work) may recover at different rates. Hypothesis: We hypothesized that patients would have recovery in all domains of the CPC-E at 1 year after index cardiac arrest. Methods: A prospective cohort study of cardiac arrest survivors was conducted between 2/1/16 and 5/31/17. Chart review was done for baseline demographic data. Outcome measures including mRS, CPC, and CPC-E scores were assessed at discharge, 3 months, 6 months, and 1 year. We defined recovery of a CPC-E domain when >90% of patients had scores of 1-2 in that domain. Results: Of 71 subjects, 35 completed the CPC-E at discharge, 35 at 3 months, 25 at 6 months and 31 at 1 year. The most common reasons for exclusion were patient declined or were lost to follow up. The majority (N=37; 52%) were female, with a mean (SD) age of 58(17) years. Most arrests occurred out of hospital (N= 49; 69%), 27 (38%) had a shockable rhythm and the majority (N=37; 54%) were discharged home. CPC-E domains of alertness (N=35, 100%) logical thinking (N=35; 100%), and attention (N=33; 94%) recovered by hospital discharge. BADLs were recovered by 3 months (N=33; 94%). The majority of patients (N=24;77%) experienced slight-to-no disability or symptoms (mRS 0-2 / CPC 1-2) at 1 year follow up. CPC-E short term memory (67%), motor (87%), mood (87%), fatigue (13%), complex ADL (74%), and return to work (55%) did not recover fully by 1 year. Conclusions: In survivors of cardiac arrest, CPC-E domains of alertness, logical thinking, and attention recover rapidly, while domains of short term memory, motor, mood, fatigue, complex ADL and ability to return to work are chronically impaired 1 year after arrest. Interventions to improve recovery in these domains are needed.

Abstract 48: Neurological Outcomes of Inpatient Cardiopulmonary Resuscitation in a University Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lia M Thomas ◽  
Miguel Benavides ◽  
Pierre Kory ◽  
Samuel Acquah ◽  
Steven Bergmann
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Cardiopulmonary Arrest ◽  
University Hospital ◽  
Neurological Dysfunction ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Neurologically Intact

Background: Despite advances in out- of- hospital resuscitation practices, the prognosis of most patients after a cardiac arrest remains poor. The long term outcomes of patients successfully resuscitated from cardiac arrest are often complicated by neurological dysfunction. Therapeutic hypothermia has significantly improved neurological outcomes in patients successfully resuscitated from out- of- hospital cardiac arrests. The objective of this study was to look into the neurological outcomes in inpatients after successful cardiopulmonary resuscitation (CPR) in a university hospital setting. Methods: This was a retrospective observational study of 68 adult patients who experienced cardiac or respiratory arrest over an 18 month period at a metropolitan teaching hospital with dedicated, trained code teams. Arrests that occurred in the Emergency Department, Critical Care Units or Operating Rooms were excluded. Results: Of the 68 consecutive patients included in this study, 53% were resuscitated successfully. However, only 12 (18%) survived to discharge from the hospital and only 6 (10%) were discharged with intact neurological status. The initial survival was better in patients who received prompt CPR and in those with less co - morbidities. Pulseless electrical activity (PEA) or asystole were the most common rhythms (47% of the arrests). Most patients who survived and were neurologically intact had PEA (67%). We believe that most PEA arrests were more likely severe hypotension with the inability to palpate a pulse rather than true PEA. The mean time to defibrillation for all patients with an initial shockable rhythm (n=5) was 8.2 minutes. Patients who had an initial shockable rhythm and survived to discharge were shocked within 1 minute (n=2). Conclusion: Despite advances in critical care, survival from inpatient cardiopulmonary arrest to neurologically intact discharge remains poor. Therapeutic hypothermia should be expanded to those resuscitated from in - hospital cardiopulmonary arrest to determine if neurological outcomes would improve.

Abstract 312: The Impact of Sedation on Quantitative Electroencephalogram Trends and Neurological Outcomes in a Mouse Model of Cardiac Arrest and Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Takamitsu Ikeda ◽  
Yusuke Miyazaki ◽  
Eizo Marutani ◽  
Fumito Ichinose
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Function ◽  
Temperature Management ◽  
Vehicle Group ◽  
Altered Level ◽  
Eeg Activity ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
The Impact

Introduction: The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although most CA survivors are sedated during targeted temperature management, the effects of sedation on post-arrest outcomes remain to be determined. Hypothesis: Sedation after CA improves neurological outcomes by modulating cerebral electrical activity and metabolism. Methods: Ten to 14 days after implantation of EEG transmitters, adult male C57BL/6J mice were subjected to CA and cardiopulmonary resuscitation (CPR). After return of spontaneous circulation (ROSC), mice received intravenous infusion of propofol, dexmedetomidine (DEX), or normal saline (vehicle) for 2 hours. Body temperature was maintained at 37°C, and was subsequently lowered to 33°C. Cerebral blood flow (CBF) was measured for 4 hours following ROSC. To quantify time-dependent EEG changes, we calculated the sum of the Delta, Theta, and Alpha band power in consecutive 12-hour intervals after ROSC (D 0-12 and D 12-24 , T 0-12 and T 12-24 , and A 0-12 and A 12-24 , respectively). Because the increase in fast EEG activity over time may reflect neurological recovery after CA, we compared the ratios of D 12-24 to D 0-12 , of T 12-24 to T 0-12 , and of A 12-24 to A 0-12 among groups. Results: As compared with vehicle-treated mice, propofol- or DEX-treated mice exhibited improved survival rate and neurological function after CA, though no difference was found between propofol- and DEX-treated mice. In the vehicle group, CBF was higher than the baseline after ROSC, while the increase in CBF was attenuated in the propofol and DEX group. The values of A 12-24 /A 0-12 and T 12-24 /T 0-12 were significantly higher in propofol- and DEX-treated mice than in vehicle-treated mice ( P = 0.017 and P = 0.004, respectively, propofol vs vehicle; P = 0.038 and P = 0.002, respectively, DEX vs vehicle), but there was no significant difference in D 12-24 /D 0-12 among groups. In all post-arrest mice, both A 12-24 /A 0-12 and T 12-24 /T 0-12 were positively correlated with better neurological function at 24 and 48 hours after CA. Conclusions: Post-arrest sedation was associated with a reduction in CBF and a greater recovery of fast EEG activity after CA, and improved neurological outcomes and survival in mice.

P5349Platelet/lymphocyte ratio as an inflammatory marker and predictor of short-term neurological outcomes in survivors after cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rodriguez ◽  
L A Martinez ◽  
S O Rosillo ◽  
L Martin ◽  
C Merino ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Paired Comparison ◽  
Inflammatory Marker ◽  
Cerebral Performance Category ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Early Assessment ◽  
Lymphocyte Ratio ◽  
Neurological Outcomes ◽  
The Impact

Abstract Background Platelet/lymphocyte ratio (PLR), an inflammatory marker associated with poor outcomes in different clinical situations, may play a role in the proinflammatory state triggered during hypoxic-ischemic brain injury secondary to cardiac arrest. Purpose To study PLR dynamics and its relationship with neurologic outcomes in survivors after CA treated with target-temperature-management (TTM). Methods Observational retrospective study from a prospective database of survivors of in-hospital and out-of-hospital CA admitted to our Acute Cardiac Care Unit between August 2006 to December 2018. All patients received TTM according to our local protocol. Results A total of 466 patients were included. Mean age was 62.7±14.4 years and 102 (21.9%) were women. Baseline characteristics are shown in Table 1. 430 (92.2%) of CA were witnessed, 312 (67.0%) had ventricular fibrillation as initial cardiac rhythm. Among them, 236 (51.1%) survived until hospital discharge and 208 (45.1%) presented favorable neurological outcomes (a score 1 or 2 on cerebral performance category (CPC)). The mean value of PLR at admission and during targeted temperature was 100.4±5.2 and 224.5±7.3 respectively (mean difference 123.1±7.1, p<0.0001). This increase in PLR was significantly higher among patients with worse neurological outcomes (CPC 3–5, mean DPLR 138.2±5.5) at 3 months compared with survivors with CPC 1–2 (mean DPLR 108.2±6.3, p=0.0348 for paired comparison between both groups). Table 1 Hypertension, n (%) 235 (54.9) Diabetes, n (%) 113 (26.4) Dyslipidaemia, n (%) 171 (40.0) Smocking habit, n (%) 208 (48.5) Time to ROSC mean ± SD, min 26.6±18.6 Mean arterial pressure at HA mean±DS, mmHg 81.3±22.1 pH at HA mean ± SD 7.18±0.16 Lactic at HA mean ± SD 6.37±4.42 ROSC: return of spontaneus circulation; HA: hospital admission. Conclusion Our findings reflect the impact of inflammation in neurological outcomes after OHCA treated with TTM. Major increases of PLR constitute a novel marker of poor prognosis during early assessment of OHCA patients.

scholarly journals Association of Taurine with In-Hospital Mortality in Patients after Out-of-Hospital Cardiac Arrest: Results from the Prospective, Observational COMMUNICATE Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1405 ◽  
Author(s):  
Naemi Herzog ◽  
Rahel Laager ◽  
Emanuel Thommen ◽  
Madlaina Widmer ◽  
Alessia M. Vincent ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
University Hospital ◽  
Neurological Deficits ◽  
Receiver Operating Curve ◽  
Taurine Concentration ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background: Studies have suggested that taurine may have neuro- and cardio-protective functions, but there is little research looking at taurine levels in patients after out-of-hospital cardiac arrest (OHCA). Our aim was to evaluate the association of taurine with mortality and neurological deficits in a well-defined cohort of OHCA patients. Methods: We prospectively measured serum taurine concentration in OHCA patients upon admission to the intensive care unit (ICU) of the University Hospital Basel (Switzerland). We analyzed the association of taurine levels and in-hospital mortality (primary endpoint). We further evaluated neurological outcomes assessed by the cerebral performance category scale. We calculated logistic regression analyses and report odds ratios (OR) and 95% confidence intervals (CI). We calculated different predefined multivariable regression models including demographic variables, comorbidities, initial vital signs, initial blood markers and resuscitation measures. We assessed discrimination by means of area under the receiver operating curve (ROC). Results: Of 240 included patients, 130 (54.2%) survived until hospital discharge and 110 (45.8%) had a favorable neurological outcome. Taurine levels were significantly associated with higher in-hospital mortality (adjusted OR 4.12 (95%CI 1.22 to 13.91), p = 0.02). In addition, a significant association between taurine concentration and a poor neurological outcome was observed (adjusted OR of 3.71 (95%CI 1.13 to 12.25), p = 0.03). Area under the curve (AUC) suggested only low discrimination for both endpoints (0.57 and 0.57, respectively). Conclusion: Admission taurine levels are associated with mortality and neurological outcomes in OHCA patients and may help in the risk assessment of this vulnerable population. Further studies are needed to assess whether therapeutic modulation of taurine may improve clinical outcomes after cardiac arrest.

scholarly journals Impact of Cardiopulmonary Resuscitation Duration on the Neurological Outcomes of Out-of-Hospital Cardiac Arrest

2021 ◽  
Author(s):  
HISSAH ALBINALI ◽  
Arwa Alumran ◽  
Saja AlRayes
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Bivariate Analysis ◽  
Neurological Outcomes ◽  
Risk Of Death ◽  
Secondary Hospital ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background: Patients experiencing cardiac arrest outside medical facilities are at greater risk of death and might have negative neurological outcomes. Cardiopulmonary resuscitation duration affects neurological outcomes of such patients, which suggests that duration of CPR may be vital to patient outcomes.Objectives: The study aims to evaluate the impact of cardiopulmonary resuscitation duration on neurological outcome of patients who have suffered out-of-hospital cardiac arrest.Methods: Data were collected from emergency cases handled by a secondary hospital in industrial Jubail, Saudi Arabia, between 2015 and 2020. There were 257 out-of-hospital cardiac arrest cases, 236 of which resulted in death.Results: Bivariate analysis showed no significant association between cerebral performance category (CPC) outcomes and duration of CPR, gender and cause of death whereas there is statistically significant between CPC and age. (p = 0.001). However, a good CPC outcome was reported with a (mean) limited duration of 8.1 min of CPR; whereas, poor CPC outcomes were associated with prolonged periods of CPR, 13.2 min (mean). Similarly, youthfulness was associated with good CPC outcomes as revealed by the mean age of 5.8 years, whereas a mean rank of 14.9 years was aligned with a poor CPC outcome.Conclusion: Cardiopulmonary Resuscitation Duration out-of-hospital cardiac arrest does not significantly influence the patient neurological outcome in the current study hospital. Other variables may have a more significant effect.

THE APPLICATION OF THE NEW 2015 AHA GUIDELINES ON UPDATE FOR CARDIOPULMONARY RESUSCITATION AND EMERGENCY CARDIOVASCULAR CARE: ON OCCASION OF A SUCCESSFUL CASE AT HANOI MEDICAL UNIVERSITY HOSPITAL

2017 ◽  
pp. 96-99
Author(s):  
Bui Hai Hoang ◽  
Dinh Hung Vu
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
University Hospital ◽  
Temperature Management ◽  
Key Words Cardiac Arrest ◽  
Successful Case ◽  
St Elevation ◽  
Medical University

Cardiac arrest is associated with high mortality if without early diagnosis and cardiopulmonary resuscitation. Each minute without emergency cardiopulmonary resuscitation (CPR), the patient’s chance of survival is reduced by ten percent, even if properly resuscitated but not recirculated, the chance of survival is reduced by four percent. Therefore, CPR should be ferformed as soon as patient is diagnosed with cardiac arrest with the signs of unconsciousness, apnea, loss of carotid pulse and inguinal pulse. Chest compression plays an important role in the success of CPR. There is emphasis on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation. Emergency coronary angiography is recommended for all patients with ST elevation and for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected. All adult patients with return of spontaneous circulation after cardiac arrest should have targeted temperature management (TTM) to prevent poor neurologic outcome. Key words: Cardiac arrest, targeted temperature management, the 2015 AHA Guideline on CPR and ECC

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