P1700Atrial fibrillation with CRBBB highly predict hospital mortality in the AMI patients presenting with out-of-hospital cardiac arrest after return of spontaneous circulation

Abstract Approximately 70% of survivals of out-of-hospital cardiac arrest (OHCA) have coronary artery disease, with acute vessel occlusion observed in 50%. The use of ECG to predict mortality and neurological outcomes in acute myocardial infarction (AMI) patients successfully resuscitated for OHCA has not been well-determined. Between May, 2016 and July, 2018, 1428 consecutive patients with OHCA visited the emergency department of Far Eastern Memorial Hospital, New Taipei City, Taiwan. A total number of 117 patients with return-of-spontaneous-circulation (ROSC) were diagnosed of AMI, mostly confirmed by coronary angiography. The mean age was 60.0±13.6 (mean SD) with male gender 105/117. Endpoint was mortality in hospital. The hospital mortality rate was 44.4%. Wide QRS duration (>120ms; 48.1%), complete right bundle branch block (33.3%) and atrial fibrillation (59.3%) occurred frequently in the first ECG of post-rescuscitation patients. Patient with wide QRS duration (correlation coefficient, CC: 0.350; p=0.074) and atrial fibrillation (CC: 0.287; p=0.147) had a trend towards higher mortality rate. Complete right bundle branch block (CRBBB) on the first ECG post resuscitation (CC: 0.632; p<0.001) and ST depression on first ECG post resuscitation (CC: 0.481; p=0.011) were associated with worse outcome (Mortality). Shockable rhythm (Ventricular tachycardia or fibrillation) during CPR (CC: −0.635; p<0.001), and sinus rhythm on first ECG (CC: −0.474; p=0.012) were associated better outcome (survival and neurological recovery). The combination two ECG characteristics of atrial fibrillation and CRBBB on the first ECG post resuscitation was highly associated with in-hospital mortality (CC: 0.725; p<0.001). It had a 66.7% sensitivity, 93.3% specificity, 88.9% positive predictive value, and 78.9% negative predictive value for predicting mortality. In conclusion, atrial fibrillation with CRBBB on the first ECG post resuscitation is the best predictors for unfavorable neurological outcome and mortality.

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Association between Body Mass Index and Outcomes in Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168389 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8389

Author(s):

Heekyung Lee ◽

Hyungoo Shin ◽

Jaehoon Oh ◽

Tae Ho Lim ◽

Bo-Seung Kang ◽

...

Keyword(s):

Body Mass Index ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Spontaneous Circulation ◽

Normal Weight ◽

Risk Of Bias ◽

Return Of Spontaneous Circulation ◽

Neurological Outcomes ◽

Underweight Patients ◽

Hospital Cardiac Arrest

Increased body mass index (BMI) is a risk factor for cardiovascular disease, stroke, and metabolic diseases. A high BMI may affect outcomes of post-cardiac arrest patients, but the association remains debatable. We aimed to determine the association between BMI and outcomes in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library. Studies that included patients who presented ROSC after OHCA, had a recorded BMI, and were assessed for neurological outcomes and in-hospital mortality were included. To assess the risk of bias of each included study, we employed the Risk of Bias Assessment Tool for Non-randomized Studies. We assessed 2427 patients from six studies. Neurological outcomes were significantly poorer in underweight patients (risk ratio (RR) = 1.21; 95% confidence interval (CI) = 1.07–1.37; p = 0.002; I2 = 51%) than in normal-weight patients. Additionally, in-hospital mortality rate was significantly higher in underweight patients (RR = 1.35; 95% CI = 1.14–1.60; p<0.001; I2 = 21%) and in obese patients (RR = 1.25; 95% CI = 1.12–1.39; p<0.001; I2 = 0%) than in normal-weight patients. Poor neurological outcome is associated with underweight, and low survival rate is associated with underweight and obesity in patients with ROSC after OHCA.

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Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2021.03.028 ◽

2021 ◽

Vol 60 (4) ◽

pp. 580-581

Author(s):

Vivian Diep ◽

Nhan “Marc” Phan

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

PLoS ONE ◽

10.1371/journal.pone.0175257 ◽

2017 ◽

Vol 12 (4) ◽

pp. e0175257 ◽

Cited By ~ 4

Author(s):

Hiroyuki Koami ◽

Yuichiro Sakamoto ◽

Ryota Sakurai ◽

Miho Ohta ◽

Hisashi Imahase ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Arrest ◽

Spontaneous Circulation ◽

Adult Patients ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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The association between end-tidal CO2 and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity

Resuscitation ◽

10.1016/j.resuscitation.2021.08.014 ◽

2021 ◽

Vol 167 ◽

pp. 76-81

Author(s):

Michael Crickmer ◽

Ian R. Drennan ◽

Linda Turner ◽

Sheldon Cheskes

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

End Tidal ◽

Hospital Cardiac Arrest ◽

End Tidal Co2

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Development and validation of early prediction for neurological outcome at 90 days after return of spontaneous circulation in out-of-hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2021.09.027 ◽

2021 ◽

Vol 168 ◽

pp. 142-150

Author(s):

Norihiro Nishioka ◽

Daisuke Kobayashi ◽

Takeyuki Kiguchi ◽

Taro Irisawa ◽

Tomoki Yamada ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

Early Prediction ◽

Return Of Spontaneous Circulation ◽

Development And Validation ◽

Hospital Cardiac Arrest

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Abstract 11372: A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.144.suppl_2.11372 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Andy T Tran ◽

Anthony Hart ◽

John Spertus ◽

Philip Jones ◽

Bryan McNally ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Risk Adjustment ◽

Quality Measures ◽

Coronary Intervention ◽

Spontaneous Circulation ◽

Logistic Regression Models ◽

Adjustment Model ◽

Risk Adjustment Model ◽

Hospital Cardiac Arrest

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

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Abstract P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year

Circulation ◽

10.1161/circ.118.suppl_18.s_1463 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jocelyn Berdowski ◽

Andra Schmohl ◽

Rudolph W Koster

Keyword(s):

Cardiac Arrest ◽

World Wide ◽

Prospective Observational Study ◽

Spontaneous Circulation ◽

Chest Compressions ◽

Return Of Spontaneous Circulation ◽

Resuscitation Guidelines ◽

Rhythm Analysis ◽

New Guidelines ◽

Hospital Cardiac Arrest

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines. Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005). Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1 ). Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.

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Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽

10.1161/circ.130.suppl_2.13131 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Shuichi Hagiwara ◽

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Kei Hayashida ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Statistical Significance ◽

Coronary Arteriography ◽

Spontaneous Circulation ◽

P Value ◽

Return Of Spontaneous Circulation ◽

Overall Performance ◽

The Mean ◽

Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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