scholarly journals Clinical significance of early echocardiography after out-of-hospital cardiac arrest on arrival to a heart attack centre

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Kanyal ◽  
D Sarma ◽  
N Pareek ◽  
R Dworakowski ◽  
N Melikian ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
Low Flow ◽  
Epinephrine Administration ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Hospital Cardiac Arrest

Abstract Background Left ventricular systolic dysfunction (LVSD) is common after out of hospital cardiac arrest (OOHCA) and can manifest as global or regional change. Purpose We evaluated the extent of global and regional LVSD and its association with coronary artery disease (CAD) and outcome in those undergoing coronary angiography after OOHCA. Methods 619 patients with OOHCA were admitted at our centre between 1st May 2012 and 31st December 2017. 398 patients were included. Rates of cardiogenic shock and extent of CAD, as classified by the SYNTAX score were measured. The primary endpoint was 12-month mortality. Patients with incomplete data were excluded from the analysis. Results Two hundred and sixty-six patients (median age 62 [53–71] 76.3% male) underwent both trans-thoracic echocardiography andcoronary angiography on arrival and were included in the final analysis. 81.6% had ventricular fibrillation, 83.5% were witnessed and 51.9% occurred at residence. Ninety-six patients (36%) had significant LVSD (Left Ventricular Ejection Fraction [LVEF] <40%) and 139 (52.2%) patients had regional wall motion abnormalities (RWMAs) on arrival. Patients were classified into 4 groups (Group A: LVEF <40%/Global, Group B: LVEF <40%/RWMA, Group C: LVEF ≥40%/Global and Group D: LVEF ≥40%/RWMA) with frequencies of 10.9%, 25.2%, 41.4% and 22.6%). Patients in Group D had the shortest low-flow times and lowest rates of epinephrine administration, with most favourable metabolic status on arrival, based on lactate and creatinine values. In Groups B and D (RWMAs), patients were significantly more likely to have a post-ROSC ECG demonstrating ST elevation/LBBB and absence of epinephrine administration during resuscitation with shorter low flow times. Extent of CAD was similar between the four groups. From patients with LVEF ≥40%, patients in Group C had substantially lower SYNTAX scores than compared with Group D (0.5 vs 13.5, p<0.001). However, both Group B and C (RWMA) groups had highest rates of culprit lesions compared with matched global groups which was reflected in higher PCI rates (Figure 1). The primary endpoint of 12-month mortality was lowest in Group D and highest in the Group A group. A similar effect was observed for poor neurological outcome and 30-day mortality. Patients with regional LVSD had significantly improved survival at 12 months compared with those with global LVSD (70.5% vs 48.3%, p<0.001) vs 51). Those in Group D had highest survival at 12 months, while this was similar for Groups B and C and lowest in Group A (Figure 2). Cardiac aetiology death was significantly higher in those with LVEF <40% compared to those with LVEF ≥40% (70.5% vs 48.3%, p<0.001). Conclusions Patients with significant LVEF <40% have higher rates of cardiogenic shock and mortality which was driven by cardiac aetiology death, while presence of RWMAs are associated with a higher rate of culprit coronary lesions and improved outcome FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Duration of resuscitation efforts and long-term prognosis following in-hospital cardiac arrest (IHCA)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Yonis ◽  
B Winkel ◽  
M P Andersen ◽  
M Wissenberg ◽  
L Kober ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Nursing Home ◽  
Brain Damage ◽  
Nursing Home Admission ◽  
Group A ◽  
Long Term Prognosis ◽  
Group B ◽  
Group D ◽  
Hospital Cardiac Arrest

Abstract Background The decision to terminate resuscitation efforts can be challenging. Notably, the association between duration of resuscitation and long-term survival and functional outcomes after in-hospital cardiac arrest (IHCA) is unknown. Purpose To examine 30-day and 1-year survival stratified by duration of resuscitation efforts. Further, to report long term outcome (1-year survival) without anoxic brain damage or nursing home admission among 30-day IHCA survivors. Methods We included all patients with IHCA from 13 Danish hospitals between January 1st, 2013 to December 31st, 2015. Patients were only included if there was clinical indication for a resuscitation attempt. Data on IHCA was obtained from the DANARREST database, which was linked to national registries to retrieve information on patient characteristics, survival, anoxic brain damage and nursing home admission. Patients were stratified into four groups (A-D) according to quartiles of duration of resuscitation efforts: Group A (<5 minutes), group B (5–11 minutes), group C (12–20 minutes) and group D (≥21 minutes). Using multivariable regression analysis, outcomes were standardized for patient age, sex, Charlson Comorbidity Index, witnessed arrest, monitored arrest, cardiopulmonary resuscitation (CPR) prior to arrival of the in-hospital cardiac arrest team and defibrillation. Results The study population comprised of 1868 patients, median age was 74 (1st-3rd quartile [Q1-Q3] 65–81 years) and 65.0% were men. In total, 52.1% (n=973) of the patients achieved return of spontaneous circulation (ROSC). The overall median duration of resuscitation was 12 min (Q1-Q3 5–21 min). The standardized absolute chance of 30-day survival was 63.6% (95% CI 58.0%-69.0%) for group A, 34.0% (95% CI 29.7%-38.2%) for group B, 14.1% (95% CI 10.7%-17.5%) for group C and 9.0% (95% CI 6.8%-11.8%) for group D. Similarly, the chance of 1-year survival was highest for group A (51.5%; 95% CI 46.3%-56.7%) gradually decreasing to 7.0% (95% CI 4.5%-9.5%) in group D (Fig. 1). Among 30-day survivors of an IHCA, the standardized absolute chance of survival without anoxic brain damage or nursing home admission within one-year post-arrest was highest for patients resuscitated in group A (83.2%; 95% CI 78.4%-88.1%), decreasing to 72.3% (95% CI 64.5%-80.0%) in group B, 68.3% (95% CI 55.3%-81.2%) in group C and 71.1% (95% CI 54.2%-88.0%) in group D (Fig. 2). Conclusion Short time to ROSC after in-hospital cardiac arrest is associated with better long-term prognosis. However, the majority of 30-day survivors are alive 1-year post-arrest without anoxic brain damage and without need for nursing home admission despite prolonged resuscitation. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals AB0422 LEFT VENTRICULAR ABNORMALITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS FOLLOWED BY SEQUENTIAL ECHOCARDIOGRAPHY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1510.1-1511
Author(s):  
T. Kuga ◽  
M. Matsushita ◽  
K. Tada ◽  
K. Yamaji ◽  
N. Tamura
Keyword(s):  
Lupus Erythematosus ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Monocyte Count ◽  
Lv Dysfunction ◽  
Group A ◽  
Group B ◽  
Lv Diastolic Dysfunction ◽  
Group D

Background:Cardiovascular disease (CVD) is detected in up to 50% of systemic lupus erythematosus (SLE) patients1and major cause of death2. Even clinically silent SLE patients can develop left ventricular (LV) diastolic dysfunction3. Proper echocardiographic follow up of SLE patients is required.Objectives:To clarify how the prevalence of LV abnormalities changes over follow-up period and identify the associated clinical factors, useful in suspecting LV abnormalities.Methods:29 SLE patients (24 females and 5 men, mean age 52.8±16.3 years, mean disease duration 17.6±14.5 years) were enrolled. All of them underwent echocardiography as the baseline examination and reexamined over more than a year of follow-up period(mean 1075±480 days) from Jan 2014 to Sep 2019. Patients complicated with pulmonary artery hypertension, deep venous thrombosis or pulmonary embolism and underwent cardiac surgery during the follow-up period were excluded. Left ventricular(LV) systolic dysfunction was defined as ejection fraction (EF) < 50%. LV diastolic dysfunction was defined according to ASE/EACVI guideline4. LV dysfunction (LVD) includes one or both of LV systolic dysfunction and LV diastolic function. Monocyte to HDL ratio (MHR) was calculated by dividing monocyte count with HDL-C level.Prevalence of left ventricular abnormalities was analysed at baseline and follow-up examination. Clinical characteristics and laboratory data were compared among patient groups as follows; patients with LV dysfunction (Group A) and without LV dysfunction (Group B) at the follow-up echocardiography, patients with LV asynergy at any point of examination (Group C) and patients free of LV abnormalities during the follow-up period (Group D).Results:At the baseline examination, LV dysfunction (5/29 cases, 13.8%), LV asynergy (6/29 cases, 21.7%) were detected. Pericarditis was detected in 7 patients (24.1%, LVD in 3 patients, LV asynergy in 2 patients) and 2 of them with subacute onset had progressive LV dysfunction, while 5 patients were normal in echocardiography after remission induction therapy for SLE. At the follow-up examination, LV dysfunction (9/29 cases, 31.0%, 5 new-onset and 1 improved case), LV asynergy (6/29 cases, 21.7%, 2 new-onset and 2 improved cases) were detected. Though any significant differences were observed between Group A and Group B at the baseline, platelet count (156.0 vs 207.0, p=0.049) were significantly lower in LV dysfunction group (Group A) at the follow-up examination. Group C patients had significantly higher uric acid (p=0.004), monocyte count (p=0.009), and MHR (p=0.003) than Group D(results in table).Conclusion:LV dysfunction is progressive in most of patients and requires regular follow-up once they developed. Uric acid, monocyte count and MHR are elevated in SLE patients with LV asynergy. Since MHR elevation was reported as useful marker of endothelial dysfunction5, our future goal is to analyse involvement of monocyte activation and endothelial dysfunction in LV asynergy of SLE patients.References:[1]Doria A et al. Lupus. 2005;14(9):683-6.[2]Manger K et al. Ann Rheum Dis. 2002 Dec;61(12):1065-70.[3]Leone P et al. Clin Exp Med. 2019 Dec 17.[4]Nagueh SF et al. J Am Soc Echocardiogr. 2016 Apr;29(4):277-314.[5]Acikgoz N et al. Angiology. 2018 Jan;69(1):65-70.Numbers are median (interquartile range), Mann-Whitney u test were performed, p value less than 0.05 was considered statistically significant.Disclosure of Interests: :None declared

scholarly journals Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

2020 ◽  
Author(s):  
Diana A Gorog ◽  
Susanna Price ◽  
Dirk Sibbing ◽  
Andreas Baumbach ◽  
Davide Capodanno ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
High Risk ◽  
Cardiogenic Shock ◽  
Antithrombotic Therapy ◽  
Left Ventricular ◽  
Position Paper ◽  
Ventricular Assist Devices ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Timely and effective antithrombotic therapy is critical to improving outcome, including survival, in patients with acute coronary syndrome (ACS). Achieving effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in high-risk ACS patients, especially those with cardiogenic shock (CS) or those successfully resuscitated following out-of-hospital cardiac arrest (OHCA), who have a 30-50% risk of death or a recurrent ischaemic event over the subsequent 30 days. There are unique challenges to achieving effective and safe antithrombotic treatment in this cohort of patients that are not encountered in most other ACS patients. This position paper focuses on patients presenting with CS or immediately post-OHCA, of presumed ischaemic aetiology, and examines issues related to thrombosis and bleeding risk. Both the physical and pharmacological impacts of CS, namely impaired drug absorption, metabolism, altered distribution and/or excretion, associated multiorgan failure, co-morbidities and co-administered treatments such as opiates, targeted temperature management, renal replacement therapy and circulatory or left ventricular assist devices, can have major impact on the effectiveness and safety of antithrombotic drugs. Careful attention to the choice of antithrombotic agent(s), route of administration, drug-drug interactions, therapeutic drug monitoring and factors that affect drug efficacy and safety, may reduce the risk of sub- or supra-therapeutic dosing and associated adverse events. This paper provides expert opinion, based on best available evidence, and consensus statements on optimising antithrombotic therapy in these very high-risk patients, in whom minimising the risk of thrombosis and bleeding is critical to improving outcome.

Abstract 11816: Sustained Ventricular Fibrillation During CPR as the Strongest Predictor for the Favorable Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients; The Multicenter Prospective Study of SAVE-J

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takahiro Nakashima ◽  
Yoshio Tahara ◽  
Satoshi Yasuda ◽  
Naoto Morimura ◽  
Ken Nagao ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Initial Rhythm ◽  
Group A ◽  
Group B ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be effective in out-of-hospital cardiac arrest (OHCA) patients in whom ventricular fibrillation (VF) as an initial rhythm were refractory to conventional cardiopulmonary resuscitation (CPR). However, it remains unclear whether ECPR is effective even though cardiac rhythm would change from VF to non-VF during CPR. Methods: This multicenter prospective observational study was conducted in 46 hospitals. A total of 457 patients with OHCA aged 20-74 years in whom initial rhythm was VF and the duration from collapse to hospital arrival was within 45 minutes were originally registered. After given CPR for more than 15 minutes in hospital, these patients received combination therapy with ECPR including therapeutic hypothermia (TH), or not received. The patients underwent ECPR (n=250) were classified into the following 2 groups according to rhythm changes during CPR; Group-A (sustained VF; n=127) and Group-B (changing from VF initially to non-shockable rhythm; n=123). The endpoint was a favorable outcome defined as Cerebral Performance Category 1-2 at 6 months after collapse. Results: There were no significant differences of age, sex, time from collapse to ECPR start and the rate of TH between the 2 groups. The rate achieving favorable outcome was significantly higher in Group-A than Group-B. (19.7% vs. 3.3%, p<0.001) (Figure1). When focusing on sustained VF (Group-A), the rate achieving favorable outcome improved about 5.5-fold by ECPR (ECPR, n=127; 19.7% vs. non-ECPR, n=55; 3.6%, p<0.001) (Figure2). In the multivariate logistic-regression analysis, sustained VF during CPR was the strongest predictor for the favorable outcomes among the pre-hospital parameters including age, bystander CPR and time from collapse to ECPR (Odds ratio 4.43, p=0.018). Conclusions: These findings indicates that the patients with sustained VF seem to be a particular population that could merit ECPR.

scholarly journals Brain Natriuretic Peptide and the Severity of Aortic Regurgitation: Is There Any Correlation?

2005 ◽  
Vol 33 (4) ◽  
pp. 454-459 ◽  
Author(s):  
M Ozkan ◽  
O Baysan ◽  
K Erinc ◽  
C Koz ◽  
M Yokusoglu ◽  
...  
Keyword(s):  
Aortic Regurgitation ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Control Group ◽  
Vena Contracta ◽  
Group A ◽  
Male Patients ◽  
Group B ◽  
Chronic Aortic Regurgitation ◽  
Group D

We aimed to evaluate the correlation between aortic regurgitation severity and brain natriuretic (BNP) levels as a marker for left ventricular dysfunction. Sixty consecutive male patients (mean age 22 ± 3 years) with isolated chronic aortic regurgitation were enrolled in the study together with a control group of 30 age-matched healthy volunteers (group A). Patients were classified with regard to aortic regurgitation vena contracta width as follows: group B, < 3 mm, mild ( n = 16); group C, ≥ 3 and < 6 mm, moderate ( n = 26); group D, ≥ 6 mm, severe ( n = 18). BNP measurements were performed with a fluorescence immunoassay kit. BNP levels were increased in patients with aortic regurgitation, and severity of regurgitation had a significant influence on BNP levels. This effect can be explained by the volume loading effect of aortic regurgitation.

Proof of concept study on the utility of integrated transthoracic and transesophageal echocardiography aortic stenosis assessment

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Schwartzenberg ◽  
A Sagie ◽  
S Kazum ◽  
I Yedidya ◽  
D Monakier ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Medical Therapy ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Low Flow ◽  
P Value ◽  
Group A ◽  
Group B ◽  
The Impact

Abstract Background Integrated echo method (IEM) combining transthoracic and transesophageal echocardiography (TTE/TEE) data can provide accurate aortic stenosis (AS) assessment. Our objectives were to evaluate the impact of IEM classification on mortality in AS patients. Methods Between 2016–2017, 63 out of 81 consecutive patients with at least moderate AS underwent comprehensive sequential TTE and TEE. AS types were determined by TTE and IEM (utilizing TEE planimetry of left ventricular outflow tract and highest Doppler spectral signals from both TTE and TEE). Based on conservative vs actionable implication, AS types were dichotomized into Group A, comprising moderate and Normal-Flow Low-Gradient (NFLG), and Group B, comprising High-Gradient (HG), Low ejection fraction Low-Flow Low-Gradient (Low EF LFLG), and Paradoxical Low-Flow Low-Gradient (PLFLG) AS. Survival under medical therapy was determined. Results Dichotomous classification was discordant in 15.9% of the patients with the two methods, with a relative risk of 1.55 of A to B Group re-classification with IEM (p&lt;0.001). The optimal cut-off value of TTE-determined AVA for AS classification was 0.82 cm2 (75% sensitivity and 87% specificity) vs an IEM-determined optimal AVA cut-off value of 0.92 cm2 (84.4% sensitivity and 76% specificity). During a median time of 9 months (quartiles 2.4–22 months) of follow-up under medical treatment, Group B patients had a worse survival under medical therapy than Group A patients, with additional independent prognostic value for Group A/B dichotomization by IEM in Group A (non-actionable) TTE-defined patients after multivariable adjustment (hazard ratio 5.3, confidence interval 1.39–20.3, p value=0.015). Conclusions IEM in patients with ambiguous AS severity can improve detection of patients who may benefit from early invasive therapy. Graphical Abstract Funding Acknowledgement Type of funding source: None

scholarly journals Association of left anterior descending artery involvement on clinical outcomes among patients with STEMI presenting with and without out-of-hospital cardiac arrest

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001065
Author(s):  
Mia Bertic ◽  
Christopher B Fordyce ◽  
Nima Moghaddam ◽  
John Cairns ◽  
Martha Mackay ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Hospital Cardiac Arrest

BackgroundST-segment elevation myocardial infarction (STEMI) outcomes are influenced by the location of the culprit vessel with worse outcomes portended with a left anterior descending (LAD) culprit lesion. However, relatively little is known about the independent association of LAD involvement with clinical outcomes of patients with STEMI with and without out-of-hospital cardiac arrest (OHCA).MethodsWe identified 91 patients with and 929 without a preceding OHCA within the Vancouver Coastal Health Authority who presented with an acute STEMI and underwent primary percutaneous coronary intervention between 26 June 2007 and 31 March 2016.ResultsPatients with STEMI with OHCA had higher rates of in-hospital cardiac arrest (43.3% vs 8.3%, p<0.001), heart failure (50.5% vs 11.3%, p<0.001), cardiogenic shock (49.5% vs 5.7%, p<0.001), mortality (35.2% vs 3.3%, p<0.001) and reduced left ventricular ejection fraction (LVEF; 42.9% vs 47.3%, p<0.001) compared with those without OHCA. Among patients without OHCA, LAD involvement was associated with increased heart failure (18.1% vs 5.2%, p<0.001), in-hospital cardiac arrest (10.7% vs 6.2%, p<0.014), cardiogenic shock (8.4% vs 3.3%, p<0.001), reduced LVEF (43.0% vs 51.2%, p<0.001) and mortality (5.2% vs 1.3%, p=0.003) compared with patients without LAD involvement. With the exception of LVEF, these associations were not seen among patients with STEMI with OHCA and an LAD culprit. The presence of an LAD culprit was not independently associated with increased hospital mortality among patients with OHCA after adjusting for potential confounding factors.ConclusionOur study has demonstrated a differential impact of LAD involvement on clinical outcomes among patients with STEMI who present with and without OHCA. Our data highlight the complexity surrounding the prognostication following OHCA complicating STEMI and demonstrate that other mechanisms other than LAD involvement contribute to the high mortality associated with OHCA as a result of STEMI.

P5028Shanghai score system into practice

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Carvalho ◽  
C Gravinese ◽  
G P Varalda ◽  
A Previti ◽  
G Mandrile ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Atrial Flutter ◽  
Febrile Illness ◽  
Holter Monitoring ◽  
Clinical History ◽  
Diagnostic Score ◽  
Group A ◽  
Group B ◽  
Group D

Abstract Background The 2016 J Wave Syndrome Consensus Report proposed the Shanghai Brugada Syndrome (BS) Score, a diagnostic score based on ECG features, genetic results, family and clinical history. Purpose The aim of our study was to reclassify our institution's BS cohort using the Shanghai BS Score. Methods We collected 170 patients with BS diagnosis (according to guidelines) who attended our outpatient clinic between 1996 and 2019. Patients were followed on an yearly basis. During follow up (FU) we looked for the appearance of a spontaneous Type 1 ECG (either with a 12 lead ECG or a 12 lead Holter monitoring) and arrhythmic events (defined as unexplained cardiac arrest or documented VF/polymorphic VT, nocturnal agonal respirations, syncope, atrial flutter/fibrillation). Genetic analysis, limited to SCN5A and SCN1B variants, was performed. We examined each item of the Shanghai BS Score at the first and the last visit at our hospital. Results At baseline all patients presented a type 1 ECG: 26 (15%) spontaneously, 2 (1%) during a febrile illness and 142 (84%) after ajmaline pharmacological challenge. 158 (93%) patients were asymptomatic while 12 (7%) presented symptoms: 1 unexplained cardiac arrest, 1 nocturnal agonal respirations, 9 syncopes, 1 atrial flutter/fibrillation under the age of 30 years. Genetic testing was performed in 73 (43%) patients; an SCN5A mutation was detected in 11 patients while a SCN1B was detected in 1 patient. According to the score we divided the patients as follows: group A 2 to 3 points 107 (63%) patients; group B 3.5 points 13 (8%) patients; group C 4 to 5 points 39 (23%) patients; group D ≥5.5 points 11 (6%) patients. During FU (medium 59 months) there were 3 (2.8%) arrhythmic events in group A (2 unexplained cardiac arrests and 1 syncope; 0 in group B; 1 (2.6%) in group C (syncope); 3 (27%) in group D (1 FV and 2 syncopes). 19 patients (11%) modified their Shanghai score during FU: 16 because of the appearance of a spontaneous type 1 ECG, 3 for their clinical history. Conclusions Although the Shanghai Score has been proposed as a diagnostic tool, data from literature show that patients with a higher score are at a progressively higher risk for VT/VF. Unexpectedly, we observed 2 unexplained cardiac arrests in the group of patients with a score 2 to 3. This may suggest the need to the use other risk criteria such as fractionated potentials or other ECG markers. Additionaly, we have shown that this Score is prone to changes over time, stressing the importance of a regular FU with continuous risk assessment.

P6357Left ventricular unloading leads to heart rhythm stabilization in cardiogenic shock - Results from the Dresden Impella Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Mierke ◽  
T Loehn ◽  
G Ende ◽  
Y Akram ◽  
S Jahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Heart Rhythm ◽  
Serum Lactate ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Hemodynamic Parameters ◽  
Lower Serum ◽  
Hospital Cardiac Arrest

Abstract Background Cardiogenic shock (CS) is often associated with severe heart rhythm disturbances (SHRD). Percutaneous left ventricular assist devices (pLVAD) can actively unload the left ventricle (LV) using a micro-axial pump and resulting in a decreased end-diastolic pressure and wall tension. These parameters are suspected to induce and maintain rhythmological instability. Purpose In the current study, we firstly describe the termination of SHRD immediately (less than 5 minutes) after LV-unloading in CS patients with previous unsuccessful antiarrhythmic treatment. Methods The Dresden Impella Registry is an ongoing single center registry. Since 2014, a total of 97 patients were included. Each of whom had received a micro-axial heart pump in refractory CS supplying a circulatory support of 3.5 l/min. We investigated the subgroup of patients which initially exhibited SHRD like ventricular tachycardia or ventricular fibrillation, and showed an immediately stabilization of heart rhythm directly after insertion of pLVAD (HRS). This subgroup was compared with the other patients of the registry (NHRS). Therefore, clinical laboratory and hemodynamic parameters were measured and analyzed. Results In 19 patients of the registry a HRS was observed. Among these patients, a CPR before pLVAD was performed in 89.5% with a mean duration of 30.7min, whereby 52.6% sustained an in-hospital cardiac arrest and 36.9% an out-of-hospital cardiac arrest respectively. In the NHRS subgroup (n=78), a CPR was performed less frequently (39.7%; p<0.001) with shorter mean duration (19.5min; p=0.016) and a lower out-of-hospital ratio (12.8%; p=0.014). The comparison of hemodynamic parameters between the HRS and NHRS cohort showed no difference in mean arterial pressure, heart rate, left ventricular ejection fraction (LVEF), and serum lactate. The mortality showed no differences between the HRS and NHRS cohort at 30 days (68.4% vs. 58.1%; p=0.413) and 90 days (78.9% vs. 66.7%; p=0.306), despite a more frequent and longer CPR with a higher ratio of out-of-hospital cardiac arrests among the HRS patients. There was also no difference in mortality between patients, who received an in-hospital CPR. However, HRS patients with in-hospital CPR showed a significantly lower serum lactate and NA dosage compared to the NHRS cohort (Figure A & B). Furthermore, NA recovery, defined as 50% decrease as compared to the initial NA dosage, occurred more frequently in the HRS group (HRS 42.9% vs. NHRS 7.1%; p=0.049). The LVEF nearly double in the HRS subgroup after LV-unloading, whereas it did not change in the NHRS subgroup (relative LVEF increase: HRS 95% vs. NHRS 15%). Figure A & B Conclusion The termination of SHRD due to LV-unloading occurred in around 20% of CS patients in Dresden Impella Registry and was associated with a lower serum lactate and NA dosage as well as an improved LVEF among patients with in-hospital CPR. Acknowledgement/Funding None

scholarly journals Complete Revascularisation is associated with Improved Survival after Out of Hospital Cardiac Arrest

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Kanyal ◽  
N Pareek ◽  
D Sarma ◽  
A Bharucha ◽  
R Dworakowski ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Final Analysis ◽  
Syntax Score ◽  
Group A ◽  
Artery Disease ◽  
Complete Revascularisation ◽  
Group B ◽  
Hospital Cardiac Arrest

Abstract Introduction Coronary artery disease (CAD) is common in patients with Out of Hospital Cardiac Arrest (OOHCA) but the clinical relevance of burden of CAD and evidence for revascularisation strategies in relation to outcomes and modes of death remains unclear. Purpose This study sought to assess the extent of CAD as defined by the SYNTAX score and prognostic value of complete compared with incomplete revascularisation by evaluating the SYNTAX revascularisation index (SRI) in patients with OOHCA. Methods 619 patients with OOHCA were admitted at our centre between 1st May 2012 and 31st December 2017. 237 were excluded for having a non-cardiac aetiology or prior neurological disability. 398 patients were included into the study and of these 272 (68.3%) had early coronary angiography (CAG) and were included in the final analysis. The baseline SYNTAX score (bSS) and residual SYNTAX score (rSS) were determined from the coronary angiograms by a cardiologist blinded to the outcome. Patients were subdivided into 4 subgroups according to quartiles of the baseline syntax score (bSS) of 0, Group A: 1–10, Group B: 11–20 and Group C: ≥21. Complete revascularisation (CR) was defined as SRI of 1 and incomplete (IR) as SRI &lt;1 where the SRI=(1-[rSS/bSS]) ×100 (Figure 1). Results Patients with a bSS of 0 were younger, had less shockable initial arrest rhythms and worse lactate and pH on arrival.Patients with bSS&gt;0 (i.e., those with coronary artery disease) had similar cardiac arrest circumstances in terms of rates of witnessed, bystander CPR and shockable rhythms. Admission metabolic status reflected by pH and lactate and rates of ST elevation/LBBB were also identical for all three groups. However, LVEF on admission decreased significantly as coronary complexity increased (P&lt;0.0001). While early angiography was more preferentially performed in those with higher coronary complexity, paradoxically, those with bSS 1–4 had highest rates of culprit lesions which was reflected in higher rates of PCI (Figure 1). 124 (45.4%) had CR compared with 54.2% with IR. CR was most likely to be achieved as the coronary complexity reduced (Group A – 71.7%, Group B – 41.1%, Group C - 23.3%). There was no difference in rates of cardiogenic shock between both groups (CR 61.1% vs. IR 69% p=ns), but patients with complete revascularisation were younger (58.8 vs 67.8, p&lt;0.0001), lower rates of hypertension and previous CABG (16.2% vs 3.2%, p≤0.0001) CR was associated with decreased mortality at 30 days (45.9% vs 34.6%, p=0.046) and 12 months (49.3% vs 35.4%, p=0.022). The lower mortality rate in CR appeared to partly be driven by lower cardiac deaths though this was not statistically significant (22% vs 7%, p=0.1) (Figure 2). Conclusions CR in a primary coronary aetiology OOHCA group is associated with reduced early and long-term mortality, which may be driven by a reduction in cardiac deaths. Prospective randomised trials in this population are warranted. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Sign in / Sign up

Export Citation Format

Share Document