P2666Association of out-of-hospital cardiac arrest occurrence time and the survival in all-Japan utstein registry: difference between international resuscitation guidelines 2005 and 2010

Abstract Background/Introduction Previous studies have shown that out-of-hospital cardiac arrest (OHCA) occurring at night have poor outcomes compared with OHCA occurring during daytime. On the other hand, nationwide OHCA outcomes have gradually improved in Japan. Purpose We sought to examine whether one-month survival of OHCA differed between daytime and nighttime occurrences, and they differed between the periods of International Resuscitation Guidelines 2005 and 2010. Methods Using the All-Japan Utstein Registry between 2005 and 2015, adult OHCA patients whose collapse was witnessed by a bystander and the call-to-hospital admission interval was shorter than 120 min were included in this study. OHCA patients were divided by period of the International Resuscitation Guideline 2005 and 2010. Guideline 2005 included years from 2006 to 2010, while Guideline 2010 included years from 2011 to 2015. The primary outcome was one-month survival with favorable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2. Daytime, evening, and night were defined as 0700 to 1459 h, 1500 to 2259 h, and 2300 to 0659 h, respectively. Results Among 479,046 cases, 20.3% revealed OHCA occurring at night. OHCA patients occurring at night had lower rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use than those occurring at both daytime and evening. In addition, of those who received bystander CPR, higher rate of patients received CPR by family members. OHCA patients occurring at night in both guideline periods had significantly worse one-month survival than those occurring during daytime (reference) (adjusted odds ratio, 0.69, 0.64; 95% confidence interval 0.65–0.72, 0.61–0.67; P<0.001, P<0.001, Guideline 2005 and 2010 respectively). OHCA patients occurring during daytime in Guideline 2010 had better one-month survival than those in Guideline 2005 (adjusted odds ratio, 1.29; 95% confidence interval 1.24–1.34; P<0.001). Conclusions One-month survival with favorable neurological outcome in OHCA patients occurring at night remains to be significantly worse than those occurring during daytime, even improved by the periods during daytime. CPR training for the family members should be more expanded and strengthened against the night time imperfection.

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Abstract 588: Extracorporeal Cardiopulmonary Resuscitation for Induction of Hypothermia in Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.118.suppl_18.s_585-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ken Nagao ◽

Kimio Kikushima ◽

Kazuhiro Watanabe ◽

Eizo Tachibana ◽

Takaeo Mukouyama ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Control Group ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hypothermia Group ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Therapeutic hypothermia is beneficial to neurological outcome for comatose survivors after out-of-hospital cardiac arrest. However, there are few data of extracorporeal cardiopulmonary resuscitation (ECPR) for induction of hypothermia for patients with out-of-hospital cardiac arrest. We did a prospective study of ECPR with hypothermia for patients with out-of-hospital cardiac arrest. The criteria for inclusion were an age of 18 to 74 years, a witnessed cardiac arrest, collapse-to-patient’s-side interval <15 minutes, cardiac arrest due to presumed cardiac etiology, and persistent cardiac arrest on ER arrival in spite of the prehospital defibrillations. After arrival at the emergency room, cardiopulmonary bypass plus intra-aortic balloon pumping was immediately performed, and then coronary reperfusion therapy during cardiac arrest was added if needed. Mild hypothermia (34°C for 3 days) was immediately induced during cardiac arrest or after return of spontaneous circulation. We selected suitable patients who received conventional CPR with normothermia among a prospective multi-center observational study of patients who had out-of-hospital cardiac arrest in Kanto region of Japan “the SOS-KANTO study” for the control group. The primary endpoint was favorable neurological outcome at the time of hospital discharge. A total of 558 patients were enrolled; 127 received ECPR with hypothermia and 431 received conventional CPR with normothermia. The ECPR with hypothermia group had significantly higher frequency of the favorable neurological outcome than the conventional CPR with normothermia group (12% vs. 2%, unadjusted odds ratio, 8.1; 95% CI; 3.2 to 20.0). The adjusted odds ratio for the favorable neurological outcome after ECPR with hypothermia was 7.4 (95% CI; 2.8 to 19.3, p<0.0001). Among the ECPR with hypothermia group, early attainment of a target core temperature of 34°C increased its efficacy (adjusted odds ratio, 0.99; 95% CI; 0.98 to 1.00, p=0.04). ECPR with hypothermia improved the chance of neurologically intact survival for adult patients with out-of-hospital cardiac arrest, and the early attainment of a target temperature enhanced its efficacy.

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Abstract 39: Atropine for Patients with Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.116.suppl_16.ii_931-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ken Nagao ◽

Tetsuya Sakamoto ◽

Masaki Igarashi ◽

Shinichi Ishimatsu ◽

Akira Sato ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Life Support ◽

Multiple Logistic Regression Analysis ◽

Pulseless Electrical Activity ◽

Similar Frequency ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

BACKGROUND AHA guidelines for cardiopulmonary resuscitation (CPR) have recommended that administration of atropine can be considered for asystole or pulseless electrical activity (PEA), because atropine has improved survival to hospital admission in a retrospective review (Ann Emerg Med, 1984), and is inexpensive, easy to administer, and has few side effects. However, there are insufficient data in humans. METHODS We assessed the effects of atropine in 7,443 adults patients with asystole or PEA arrest from the SOS-KANTO study: a prospective, multicenter, observational trial. The medications for asystole or PEA arrest were managed according to the advanced cardiovascular life support algorithm of the CPR guidelines (i.e. a 1-mg dose of epinephrine was administered intravenously every 3 to 5 minutes and a1-mg dose of atropine was administered intravenously every 3 to 5 minutes; maximum total of 3 doses). The primary endpoint was a favorable neurological outcome 30 days after cardiac arrest. RESULTS Of the 7,443 adult patients who had out-of-hospital cardiac arrest with asystole or PEA, I,708(23%) were treated with epinephrine and atropine and 5,735(77%) were treated with epinephrine. At baseline, the epinephrine and atropine group had significantly higher proportions of cardiac cause, witnessed arrest, and bystander CPR attempt than the epinephrine group. However, the two groups had a similar frequency of the favorable neurological outcome (0.3% in each group, p=0.805). Multiple logistic-regression analysis showed that the adjusted odds ratio for the favorable neurological outcome was 0.6 (95% CI 0.2–1.7, p=0.37) after epinephrine and atropine (compared with epinephrine). On the other hand, the epinephrine and atropine group had significantly higher rate of return of spontaneous circulation (ROSC) than the epinephrine group (35% vs. 23%, p<0.0001), and the adjusted odds ratio for ROSC was 1.6 (95% CI 1.4 –1.7, p<0.0001) after epinephrine and atropine (compared with epinephrine). CONCLUSIONS We demonstrated that administration of atropine during management of asystole or PEA arrest did not increase the frequency of favorable neurological outcome, although the atropine favored initial ROSC.

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Abstract 199: Pulmonary Embolism and Accidental Hypothermia Have a Favorable Outcome in Cardiac Arrest With PEA Treated by ECPR

Circulation ◽

10.1161/circ.138.suppl_2.199 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Shinichi Ijuin ◽

Akihiko Inoue ◽

Nobuaki Igarashi ◽

Shigenari Matsuyama ◽

Tetsunori Kawase ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

Neurological Outcome ◽

Cerebral Performance Category ◽

Accidental Hypothermia ◽

Neurological Outcomes ◽

Good Outcome ◽

Group B ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also not significantly different (Group G; 46.1 ± 20.2 min vs Group B; 46.8 ± 21.7 min, p=0.92). Ten patients achieved favorable neurological outcome among 39 (26%) with non-cardiac etiology. In cardiac etiology, only 3 of 29 patients (9%) had a good outcome at 1 month (p=0.08). In particular, 5 patients of 10 pulmonary embolism, and 4 of 4 accidental hypothermia responded well to ECPR with a favorable neurological outcome. Additionally, 6 of 13 (46%), who had in hospital cardiac arrest, had good outcome, whereas 7 of 55 (15%) who had out of hospital cardiac arrest, had good outcome (p=0.02). Conclusions: In our small cohort of cardiac arrest patients with pulmonary embolism or accidental hypothermia and PEA with witness, EPCR contributed to favorable neurological outcomes at 1 month.

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Admission C-reactive protein concentrations are associated with unfavourable neurological outcome after out-of-hospital cardiac arrest

Scientific Reports ◽

10.1038/s41598-021-89681-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christoph Schriefl ◽

Christian Schoergenhofer ◽

Michael Poppe ◽

Christian Clodi ◽

Matthias Mueller ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Odds Ratio ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

C Reactive Protein ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Crude Odds Ratio ◽

Reactive Protein ◽

Hospital Cardiac Arrest

AbstractWhether admission C-reactive protein (aCRP) concentrations are associated with neurological outcome after out-of-hospital cardiac arrest (OHCA) is controversial. Based on established kinetics of CRP, we hypothesized that aCRP may reflect the pre-arrest state of health and investigated associations with neurological outcome. Prospectively collected data from the Vienna Clinical Cardiac Arrest Registry of the Department of Emergency Medicine were analysed. Adults (≥ 18 years) who suffered a non-traumatic OHCA between January 2013 and December 2018, without return of spontaneous circulation or extracorporeal cardiopulmonary resuscitation therapy were eligible. The primary endpoint was a composite of unfavourable neurologic function or death (defined as Cerebral Performance Category 3–5) at 30 days. Associations of CRP levels drawn within 30 min of hospital admission were assessed using binary logistic regression. ACRP concentrations were overall low in our population (n = 832), but higher in the unfavourable outcome group [median: 0.44 (quartiles 0.15–1.44) mg/dL vs. 0.26 (0.11–0.62) mg/dL, p < 0.001]. The crude odds ratio for higher aCRP concentrations was 1.19 (95% CI 1.10–1.28, p < 0.001, per mg/dL) to have unfavourable neurological outcome. After multivariate adjustment for traditional prognostication markers the odds ratio of higher aCRP concentrations was 1.13 (95% CI 1.04–1.22, p = 0.002). Sensitivity of aCRP was low, but specificity for unfavourable neurological outcome was 90% for the cut-off at 1.5 mg/dL and 97.5% for 5 mg/dL CRP. In conclusion, high aCRP levels are associated with unfavourable neurological outcome at day 30 after OHCA.

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Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT

Health Technology Assessment ◽

10.3310/hta25250 ◽

2021 ◽

Vol 25 (25) ◽

pp. 1-166

Author(s):

Gavin D Perkins ◽

Chen Ji ◽

Felix Achana ◽

John JM Black ◽

Karl Charlton ◽

...

Keyword(s):

Cardiac Arrest ◽

Cost Effectiveness ◽

Confidence Interval ◽

Incremental Cost ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Quality Adjusted Life Year ◽

Neurological Outcomes ◽

Hospital Cardiac Arrest ◽

Quality Adjusted Life

Background Adrenaline has been used as a treatment for cardiac arrest for many years, despite uncertainty about its effects on long-term outcomes and concerns that it may cause worse neurological outcomes. Objectives The objectives were to evaluate the effects of adrenaline on survival and neurological outcomes, and to assess the cost-effectiveness of adrenaline use. Design This was a pragmatic, randomised, allocation-concealed, placebo-controlled, parallel-group superiority trial and economic evaluation. Costs are expressed in Great British pounds and reported in 2016/17 prices. Setting This trial was set in five NHS ambulance services in England and Wales. Participants Adults treated for an out-of-hospital cardiac arrest were included. Patients were ineligible if they were pregnant, if they were aged < 16 years, if the cardiac arrest had been caused by anaphylaxis or life-threatening asthma, or if adrenaline had already been given. Interventions Participants were randomised to either adrenaline (1 mg) or placebo in a 1 : 1 allocation ratio by the opening of allocation-concealed treatment packs. Main outcome measures The primary outcome was survival to 30 days. The secondary outcomes were survival to hospital admission, survival to hospital discharge, survival at 3, 6 and 12 months, neurological outcomes and health-related quality of life through to 6 months. The economic evaluation assessed the incremental cost per quality-adjusted life-year gained from the perspective of the NHS and Personal Social Services. Participants, clinical teams and those assessing patient outcomes were masked to the treatment allocation. Results From December 2014 to October 2017, 8014 participants were assigned to the adrenaline (n = 4015) or to the placebo (n = 3999) arm. At 30 days, 130 out of 4012 participants (3.2%) in the adrenaline arm and 94 out of 3995 (2.4%) in the placebo arm were alive (adjusted odds ratio for survival 1.47, 95% confidence interval 1.09 to 1.97). For secondary outcomes, survival to hospital admission was higher for those receiving adrenaline than for those receiving placebo (23.6% vs. 8.0%; adjusted odds ratio 3.83, 95% confidence interval 3.30 to 4.43). The rate of favourable neurological outcome at hospital discharge was not significantly different between the arms (2.2% vs. 1.9%; adjusted odds ratio 1.19, 95% confidence interval 0.85 to 1.68). The pattern of improved survival but no significant improvement in neurological outcomes continued through to 6 months. By 12 months, survival in the adrenaline arm was 2.7%, compared with 2.0% in the placebo arm (adjusted odds ratio 1.38, 95% confidence interval 1.00 to 1.92). An adjusted subgroup analysis did not identify significant interactions. The incremental cost-effectiveness ratio for adrenaline was estimated at £1,693,003 per quality-adjusted life-year gained over the first 6 months after the cardiac arrest event and £81,070 per quality-adjusted life-year gained over the lifetime of survivors. Additional economic analyses estimated incremental cost-effectiveness ratios for adrenaline at £982,880 per percentage point increase in overall survival and £377,232 per percentage point increase in neurological outcomes over the first 6 months after the cardiac arrest. Limitations The estimate for survival with a favourable neurological outcome is imprecise because of the small numbers of patients surviving with a good outcome. Conclusions Adrenaline improved long-term survival, but there was no evidence that it significantly improved neurological outcomes. The incremental cost-effectiveness ratio per quality-adjusted life-year exceeds the threshold of £20,000–30,000 per quality-adjusted life-year usually supported by the NHS. Future work Further research is required to better understand patients’ preferences in relation to survival and neurological outcomes after out-of-hospital cardiac arrest and to aid interpretation of the trial findings from a patient and public perspective. Trial registration Current Controlled Trials ISRCTN73485024 and EudraCT 2014-000792-11. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 25. See the NIHR Journals Library website for further project information.

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Association Between Neurological Outcomes and Extreme Hyperoxia in Patients with Out-of-Hospital Cardiac Arrest Who Underwent Extracorporeal Cardiopulmonary Resuscitation: A Retrospective Observational Study from a Multicenter Registry

10.21203/rs.3.rs-1022493/v1 ◽

2021 ◽

Author(s):

Masahiro Kashiura ◽

Hideto Yasuda ◽

Yuki Kishihara ◽

Keiichiro Tominaga ◽

Masaaki Nishihara ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Analysis Model ◽

Neurological Outcomes ◽

Arterial Blood ◽

The Impact ◽

Hospital Cardiac Arrest

Abstract Background: To investigate the impact of hyperoxia that developed immediately after extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation (ECPR) on patients’ 30-day neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This study retrospectively analyzed data from the Japanese OHCA registry from June 2014 to December 2017. We analyzed adult patients (18 years or older) who had undergone ECPR. Eligible patients were divided into the following three groups based on their initial partial pressure of oxygen in arterial blood (PaO2) levels after ECMO pump-on: normoxia group, PaO2 ≤ 200 mm Hg; moderate hyperoxia group, 200 mm Hg < PaO2 ≤ 400 mm Hg; and extreme hyperoxia group, PaO2 > 400 mm Hg. The primary and secondary outcomes were 30-day favorable neurological outcomes. Logistic regression statistical analysis model of 30-day favorable neurological outcomes was performed after adjusting for multiple propensity scores calculated using pre-ECPR covariates and for confounding factors post-ECPR.Results: Of the 34 754 patients with OHCA enrolled in the registry, 847 were included. The median PaO2 level was 300 mm Hg (interquartile range: 148–427 mm Hg). Among the eligible patients, 277, 313, and 257 were categorized as normoxic, moderately hyperoxic, and extremely hyperoxic, respectively. Moderate hyperoxia was not significantly associated with neurologically favorable outcomes compared with normoxia as a reference (adjusted odds ratio, 0.86; 95% confidence interval: 0.55–1.35; p = 0.51). However, extreme hyperoxia was associated with less neurologically favorable outcomes when compared with normoxia (adjusted odds ratio, 0.48; 95% confidence interval: 0.29–0.82; p = 0.007).Conclusions: For patients with OHCA who received ECPR, extreme hyperoxia (PaO2 > 400 mm Hg) was associated with poor neurological outcomes. Avoidance of extreme hyperoxia may improve neurological outcomes in patients with OHCA treated with ECPR.

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Abstract 114: Association of Serum Potassium Levels With Favorable Neurological Outcome After Out-of-Hospital Cardiac Arrest: The CRITICAL Study in Osaka, Japan

Circulation ◽

10.1161/circ.138.suppl_2.114 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Haruka Shida ◽

Tasuku Matsuyama ◽

Tetsuhisa Kitamura ◽

Takefumi Kishimori ◽

Kosuke Kiyohara ◽

...

Keyword(s):

Cardiac Arrest ◽

Serum Potassium ◽

Neurological Outcome ◽

Potassium Level ◽

Serum Potassium Level ◽

Cerebral Performance Category ◽

Critical Study ◽

Hospital Arrival ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Background: Little is known about the association between serum potassium levels on hospital arrival and favorable neurological outcome after out-of-hospital cardiac arrest. Objective: The purpose of this study was to assess whether serum potassium levels on hospital arrival had prognostic indications for patients with out-of-hospital cardiac arrest (OHCA). Methods: The prospective, multicenter observational study conducted in Osaka, Japan (the CRITICAL study) enrolled all consecutive OHCA patients transported to 14 participating institutions from July 2012 through December 2015. We included adult patients aged ≥ 18 years with OHCA of cardiac origin who achieved return of spontaneous circulation (ROSC) and whose serum potassium level on hospital arrival was available. Based on the serum potassium level on hospital arrival, patients were divided into five quintiles (Q1-Q5), namely, Q1 (<3.7mEq/l), Q2 (3.7-4.2mEq/l), Q3 (4.2-5.0mEq/l), Q4 (5.0-6.1mEq/l), and Q5 (>6.1mEq/l). The primary outcome was one-month survival with favorable neurological outcome, which was defined as cerebral performance category scale 1 or 2. Results: During the study period, a total of 7373 patients were registered and 1148 of them were eligible for our analyses. The highest proportion of favorable neurological outcome was 42.2% (113/268) in the Q1, followed by 37.6% (76/202), 20.6% (50/243), 6.9% (15/216), and 2.7% (6/219) in the Q2, Q3, Q4, and Q5 (p<0.001). In the multivariable logistic regression analysis, the adjusted proportion of favorable neurological outcome decreased as serum potassium level increased (p for trend <0.001). In the subgroup analyses stratified by the first documented rhythm and estimated glomerular filtration rate, the adjusted proportions of favorable neurological outcome indicated similar tendency with those in the main analysis. Conclusion: Higher serum potassium level was significantly and independently associated with poor neurological outcome. Serum potassium on hospital arrival may be effective as a prognostic indication for out-of-hospital cardiac arrest achieving ROSC.

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Abstract 207: The Association of Academia With Neurological Outcome Among Out-Of-Cardiac Arrest Patients Who Undergo Extracorporeal Cardio-Pulmonary Resuscitation

Circulation ◽

10.1161/circ.140.suppl_2.207 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Yohei Okada ◽

Takeyuki Kiguchi ◽

Tetsuhisa Kitamura ◽

Takashi Kawamura ◽

Taku Iwami

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Cerebral Performance Category ◽

Critical Study ◽

Hospital Arrival ◽

Cardio Pulmonary Resuscitation ◽

Poor Neurological Outcome ◽

Favorable Neurological Outcome ◽

Cardiac Arrest Survival ◽

Hospital Cardiac Arrest

Background: Our study aim was to identify the association of acidemia with neurological outcome among the out-of-hospital cardiac arrest patients who undergo extracorporeal cardio-pulmonary resuscitation (E-CPR). Method: We analyzed the data from multi-institutional prospective cohort study (CRITICAL study: Comprehensive Registry of Intensive Cares for out-of-hospital cardiac arrest Survival) including 14 emergency departments in Osaka, Japan. We included adult out-of-hospital cardiac arrest patients aged ≥18 years who undergo E-CPR. The exposure of interest was serum pH measured before start to E-CPR on admission, and it was divided to tertiles. The primary outcome was 30-days favorable neurological outcome defined as cerebral performance category 1 or 2. We calculated the adjusted odds ratio (OR) with 95% confidence intervals (CI) using logistic regression model, adjusted by age, sex, witness of collapse, by-stander CPR, cardiac rhythm on hospital arrival, and time to hospital arrival. Results: Among 9,822 patients in Critical study database, 303 patients were included in the analysis. The median (interquartile range) of the age was 62 (48-71) years-old. The range of serum pH in each tertile was as below; Tertile 1[ pH≥7.02, (n=101)], Tertile 2 [pH 6.87-7.02, (n=100)], Tertile 3 [pH <6.87, (n=102)]. The adjusted OR with 95%CI of tertile2, and 3 for favorable neurological outcome were 0.23 (0.09 to 0.58), and 0.18 (0.06 to 0.52) referred to Tertile 1, respectively. Conclusion: Among the out-of-hospital cardiac arrest patients who undergo E-CPR, severe acidemia (pH < 7.02) on arrival was associated with 30-days poor neurological outcome. Serum pH measurement might be useful to consider the indication of E-CPR.

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Serum S100 Protein Is a Reliable Predictor of Brain Injury After Out-of-Hospital Cardiac Arrest: A Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.624825 ◽

2021 ◽

Vol 8 ◽

Author(s):

Martin Kleissner ◽

Marek Sramko ◽

Jan Kohoutek ◽

Josef Kautzner ◽

Jiri Kettner

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Characteristic Curve ◽

S100 Protein ◽

Cerebral Performance Category ◽

False Positive Prediction ◽

Multivariable Regression ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Purpose: To evaluate serum S100 protein at hospital admission and after 48 h in early neuroprognostication of comatose survivors of out-of-hospital cardiac arrest (OHCA).Methods: The study included 48 consecutive patients after OHCA, who survived for at least 72 h after the event. The patients were divided based on their best cerebral performance category (CPC) achieved over a 30 day follow-up period: favorable neurological outcome (CPC 1–2) vs. unfavorable neurological outcome (CPC 3–4). Predictors of an unfavorable neurological outcome were identified by multivariable regression analysis. Analysis of the receiver operating characteristic curve (ROC) was used to determine the cut-off value for S100, having a 0% false-positive prediction rate.Results: Of the 48 patients, 30 (63%) had a favorable and 18 (38%) had an unfavorable neurological outcome. Eleven patients (23%) died over the 30 day follow-up. Increased S100 levels at 48 h after OHCA, but not the baseline S100 levels, were independently associated with unfavorable neurological outcome, with an area under the ROC curve of 0.85 (confidence interval 0.74–0.96). A 48 h S100 value ≥0.37 μg/L had a specificity of 100% and sensitivity of 39% in predicting an unfavorable 30 day neurological outcome.Conclusion: This study showed that S100 values assessed 48 h after an OHCA could independently predict an unfavorable neurological outcome at 30 days.

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Survival and neurological recovery after out-of-hospital cardiac arrest

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.147 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Jarakovic ◽

S Bjelica ◽

M Kovacevic ◽

M Petrovic ◽

S Dimic ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Cerebral Performance Category ◽

Study Group ◽

St Segment Elevation ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health challenge and although rate of intrahospital survival increased over the last 40 years, it still remains poor (from 8,6% in 1976-1999 to 9,9% in 2000-2019). Different studies report that introduction of mild therapeutic hypothermia (TTM) improves survival and neurological outcome in comatose patients after OHCA. Purpose The aim of this research was to evaluate influence of pre-hospital predictors related to cardiopulmonary resuscitation (CPR), neurological status and ECG changes at admission and early percutaneous coronary intervention (PCI) performed within 24h of admission on intrahospital survival and neurological outcome of OHCA patients. Methods The research was conducted as a retrospective cohort study of data taken from the hospital registry on OHCA from January 2007 until November 2019. The analyzed factors were: bystander CPR, duration of CPR until return of ROSC, initial rhythm, responsiveness upon admission defined as Glasgow Coma Score (GCS)>8, presence of ST segment elevation (STEMI) on electrocardiography (ECG) and early PCI. The favorable neurological outcome was defined as a cerebral performance category scale (CPC)≤2. Results The research included 506 survivors of OHCA. Cardiac arrest was witnessed in 412 (81.4%), bystander CPR was performed in 197 (38.9%), CPR lasted ≤20min in 291 (57.5%), initial rhythm was shockable in 304 (60.1%) of patients. At admission 387 (76.5%) were comatose (GCS < 8) and TTM was introduced in 177 (45.7%) of patients. ECG upon admission showed STEMI in 176 (34.8%) and early PCI was performed in 145 (28.6%) of patients. In-hospital mortality in our study group was 281 (55.5%) and 185 (36.6%) of patients had favorable neurological outcome. Multivariate regression analysis showed that initial shockable rhythm (OR 3.391 [2.310-4.977], p < 0.0005), early PCI (OR 0.368 [0.226-0.599], p < 0.0005), duration of CPR ≤20min (OR 4.249 [2.688-6.718], p < 0.0005) and GCS > 8 (OR 0.194 [0.110-0.343], p < 0.0005) were independent predictors of in-hospital survival. Independent predictors of favorable neurological outcome were: initial shockable rhythm (OR 3.301 [2.002-5.441], p< 0.0005), STEMI on ECG upon admission (OR 0.528 [0.326-0.853], p = 0.009), duration of CPR ≤20min (OR 5.144 [3.090-8.565], p< 0.0005) and GCS > 8 (OR 0.152 [0.088-0.260], p< 0.0005). Introduction of TTM improved both intrahospital survival (54.1% vs. 24.4%; p < 0.0005) and neurological outcome (33.5% vs. 11.6%; p < 0.0005) in patients with initial shockable rhythm. Conclusion In our study group of OHCA patients of any origin, initial shockable rhythm, duration of CPR ≤20min and GCS > 8 at admission influenced both intrahospital survival and favorable neurological outcome. Introduction of TTM significantly improved both survival and neurological outcome in comatose patients with initial shockable rhythm.

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