scholarly journals 446 Relationship between out of hospital cardiac arrest and COVID-19 pandemic: impact on outcome

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Fulvio Lorenzo Francesco Giovenzana ◽  
Cinzia Franzosi ◽  
Paola Genoni ◽  
Michele Golino ◽  
Marta Foieni ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
First Aid ◽  
Spontaneous Circulation ◽  
Significant Difference ◽  
Few Data ◽  
Two Peaks ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Second Peak

Abstract Aims During 2020, Italy was hit by the pandemic of the ‘Coronavirus disease 2019’ (COVID-19) with an incidence/100 000 citizens characterized by two peaks. An increase in out-of-hospital cardiac arrest (OHCA) mortality during the first pandemic peak has already been described, but there are few data on the whole year. The goal of our study is to evaluate the impact of the pandemic on post-OHCA mortality. Methods We considered patients with OHCA in Varese territory from January to December 2020 with medical aetiology according with Utstein 2014 classification. The primary endpoint of the study was the assessment of acute post-arrest mortality and which parameters influence this outcome. In particular, both the role of pandemic peaks (‘first peak’ from 11 March 2020 to 23rd May 2020 and ‘second peak’ from 7 October 2020 to 31 December 2020) and the average rescue times, i.e.: (i) interval between OHCA and call for first aid (delay in activation of assistance); (ii) the interval between the call and the arrival of the rescue vehicles (delay in the arrival of the first aid) and finally; (iii) the time between the arrival of the rescue vehicles and the end of Cardiopulmonary Resuscitation (CPR), interrupted due to death or Recovery of Spontaneous Circulation (ROSC). Finally, we performed a multivariate analysis to assess which of the variables considered had the greatest impact on the outcome. Results We analysed 708 patients (mean age 76 + 14.09 years; 40% women). Overall mortality was 89%. During the peaks there was an increase in mortality compared to the pre-pandemic period (first peak 96% vs. 83%, OR 4.49; second peak 92% vs. 83%, OR 2.45) (Figure 1). The time between the collapse and the call for help was significantly higher during the first pandemic peak compared to the second peak and the pre-pandemic period (P = 0.003); the time between the call and the arrival on the patient was significantly longer during both pandemic peaks than in the previous period (P = 0.002) and there was no significant difference in CPR duration time between the periods analysed. In a multivariate model, the only time associated with an increase in mortality is the period between the call for help and the arrival on the patient, regardless of the COVID-19 pandemic. Conclusions During the COVID-19 pandemic there has been an increase in mortality of patients with OHCA. Among the variables considered, the increase in mortality is mainly associated with the delay in the arrival of emergency vehicles on site. This delay, although decreasing, was also maintained during the second peak of the pandemic.

scholarly journals Comparison of Dopamine and Norepinephrine Use for the Treatment of Hypotension in Out-Of-Hospital Cardiac Arrest Patients with Return of Spontaneous Circulation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Chao-Jui Li ◽  
Kuan-Han Wu ◽  
Chien-Chih Chen ◽  
Yat-Yin Law ◽  
Po-Chun Chuang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Study Groups ◽  
Therapeutic Agents ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
The Impact ◽  
Hospital Cardiac Arrest

In patients experiencing out-of-hospital cardiac arrest (OHCA), hypotension is common after return of spontaneous circulation (ROSC). Both dopamine and norepinephrine are recommended as inotropic therapeutic agents. This study aimed to determine the impact of the use of these two medications on hypotension. This is a multicenter retrospective cohort study. OHCA patients with ROSC were divided into three groups according to the post resuscitation inotropic agent used for treatment in the emergency department, namely, dopamine, norepinephrine, and dopamine and norepinephrine combined therapy. Thirty-day survival and favorable neurologic performance were analyzed among the three study groups. The 30-day survival and favorable neurologic performance rates in the three study groups were 12.5%, 13.0%, and 6.8% as well as 4.9%, 4.3%, and 1.2%, respectively. On controlling the potential confounding factors by logistic regression, there was no difference between dopamine and norepinephrine treatment in survival and neurologic performance (adjusted odds ratio (aOR): 1.0, 95% confidence interval (CI) 0.48–2.06; aOR: 0.8, 95% CI: 0.28–2.53). The dopamine and norepinephrine combined treatment group had worse outcome (aOR: 0.6, 95% CI: 0.35–1.18; aOR: 0.2, 95% CI: 0.05–0.89). In conclusion, there was no significant difference in post-ROSC hypotension treatment between dopamine and norepinephrine in 30-day survival and favorable neurologic performance rates.

Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ian R Drennan ◽  
Steve Lin ◽  
Kevin E Thorpe ◽  
Jason E Buick ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Injury ◽  
Good Neurologic Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

PaRamEDIc assessment of laCTate in OHCA and survival to hospital (PREDICT protocol)

2021 ◽  
Vol 13 (3) ◽  
pp. 100-104
Author(s):  
Karl Charlton ◽  
Hayley Moore
Keyword(s):  
Cardiac Arrest ◽  
Primary Outcome ◽  
Spontaneous Circulation ◽  
Prognostic Role ◽  
Single Centre ◽  
Intravenous Access ◽  
Secondary Outcomes ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Background: Studies suggest that blood lactate differs between survivors and non-survivors of out-of-hospital cardiac arrest who are transported to hospital. The prognostic role of lactate taken during out-of-hospital cardiac arrest remains unexplored. Aims: To measure the association between lactate taken during out-of-hospital cardiac arrest, survival to hospital and 30-day mortality. Methods: This is a feasibility, single-centre, prospective cohort study. Eligible for inclusion are patients aged ≥18 years suffering out-of-hospital cardiac arrest, receiving cardiopulmonary resuscitation, in the catchment of Newcastle or Gateshead hospitals, who are attended to by a study-trained specialist paramedic. Exclusions are known/apparent pregnancy, blunt or penetrating injury as primary cause of out-of-hospital cardiac arrest and an absence of intravenous access. Between February 2020 and March 2021, 100 participants will be enrolled. Primary outcome is survival to hospital; secondary outcomes are return of spontaneous circulation at any time and 30-day mortality.

Impact of Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation with Out-of-Hospital Cardiac Arrest: A Systemic Review and Meta-Analysis

2020 ◽  
Vol 35 (4) ◽  
pp. 372-381
Author(s):  
Junhong Wang ◽  
Hua Zhang ◽  
Zongxuan Zhao ◽  
Kaifeng Wen ◽  
Yaoke Xu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Meta Analysis ◽  
Systemic Review ◽  
Cochrane Library ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Impact ◽  
Hospital Cardiac Arrest

AbstractObjective:This systemic review and meta-analysis was conducted to explore the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on bystander cardiopulmonary resuscitation (BCPR) probability, survival, and neurological outcomes with out-of-hospital cardiac arrest (OHCA).Methods:Electronically searching of PubMed, Embase, and Cochrane Library, along with manual retrieval, were done for clinical trials about the impact of DA-BCPR which were published from the date of inception to December 2018. The literature was screened according to inclusion and exclusion criteria, the baseline information, and interested outcomes were extracted. Two reviewers assessed the methodological quality of the included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated by STATA version 13.1.Results:In 13 studies, 235,550 patients were enrolled. Compared with no dispatcher instruction, DA-BCPR tended to be effective in improving BCPR rate (I2 = 98.2%; OR = 5.84; 95% CI, 4.58-7.46; P <.01), return of spontaneous circulation (ROSC) before admission (I2 = 36.0%; OR = 1.17; 95% CI, 1.06-1.29; P <.01), discharge or 30-day survival rate (I2 = 47.7%; OR = 1.25; 95% CI, 1.06-1.46; P <.01), and good neurological outcome (I2 = 30.9%; OR = 1.24; 95% CI, 1.04-1.48; P = .01). However, no significant difference in hospital admission was found (I2 = 29.0%; OR = 1.09; 95% CI, 0.91-1.30; P = .36).Conclusion:This review shows DA-BPCR plays a positive role for OHCA as a critical section in the life chain. It is effective in improving the probability of BCPR, survival, ROSC before admission, and neurological outcome.

scholarly journals Out-of-hospital cardiac arrest and ambient air pollution: a dose-effect relationship and a predictive role in OHCA risk

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F R Gentile ◽  
R Primi ◽  
E Baldi ◽  
S Compagnoni ◽  
C Mare ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Dose Response ◽  
Ambient Air ◽  
Dose Effect ◽  
Lombardy Region ◽  
Short Term Exposure ◽  
Significant Difference ◽  
Low Incidence ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background Pollution has been suggested as a precipitating factor for cardiovascular diseases via a series of different mechanisms. However, data about the link between the different air pollutants and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial. Purpose The primary aim of this study is to examine the impact of short-term exposure to particulate and gaseous pollutants on the incidence of OHCA in a vast metropolitan and rural area that encompasses four provinces of the Po Valley in Northern Italy, one of the most polluted areas in Italy and Europe due to its levels of industrialization and high population density. The secondary aim of this study is to look for a dose-effect curve, which could help predict OHCA incidence based on the concentration of pollutants in a specific area. Methods This is a retrospective analysis of prospectively collected data both in the OHCA registry (Lombardia CARe) and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region. All medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 155ehab724.2654 inhabitants). Days were divided into high or low incidence of OHCA according to the median daily incidence. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant. Results The median daily incidence of OHCA was 0.3 cases/100,000 inhabitants. Benzene was the pollutant with the greatest difference between days at high and low incidence of OHCA [0.7 (IQR 0.4–1.2) vs 0.4 (IQR 0.3–0.7), p&lt;0.001], whereas SO2 had the lowest and least significant difference between the two periods [3.2 (IQR 2.8–3.6) vs 3.1 (IQR 2.7–3.5), p=0.046]. O3 showed a countertrend, being significantly higher in the low-incidence period [29.9 (IQR 10.9–61.7) vs 56.1 (IQR 25.5–74.1), p&lt;0.001] as well as temperature [10.1— (IQR 5.2–14.8) vs 15.1 (IQR 8.9–23.3), p&lt;0.001]. By using the Probit regression analysis and after adjusting for temperature, a dose-response relationship was demonstrated for all the tested pollutants. Conclusions Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models. FUNDunding Acknowledgement Type of funding sources: None.

P4169The crucial role of the bystander in out-of-hospital cardiac arrest resuscitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Campos ◽  
V Baert ◽  
H Hubert ◽  
E Wiel ◽  
N Benameur
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Survival Data ◽  
Health Concern ◽  
Propensity Analysis ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France. Purpose Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA. Methods 24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time). Results CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p<0.001). CPR performed by bystanders was associated with an increased 30-day survival rate (odds ratio 1.269; 1.207 to 1.334). The effect of bystander CPR on survival Conclusion Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.

Abstract 189: Time to Awakening in Women Compared to Men After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sarah M Perman ◽  
Shelby Shelton ◽  
Stacie L Daugherty ◽  
Edward Havranek
Keyword(s):  
Cardiac Arrest ◽  
Tertiary Care ◽  
Spontaneous Circulation ◽  
Therapeutic Interventions ◽  
Care Hospital ◽  
Single Center ◽  
Men And Women ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Background: Previous studies have shown that comatose survivors of cardiac arrest awaken approximately 3 days after return of spontaneous circulation (ROSC) however, variability in time to awakening is frequently observed. Recent data has shown that women metabolize drugs (sedatives and paralytics) differently than men. It is unknown if there are sex based differences in time to awakening for comatose survivors of cardiac arrest, and if this phenomenon might be affected by differences in withdrawal of life sustaining therapy (WLST). Objective: To determine if comatose women have different times to awakening after resuscitation from cardiac arrest. Methods: We analyzed 327 consecutive charts from a single center registry of all out of hospital cardiac arrest patients who had return of spontaneous circulation but remained comatose, cared for at an urban academic tertiary care hospital. Patient demographic and arrest characteristics were abstracted. We identified day of awakening for comatose survivors by abstracting day when Glasgow coma motor score was 6 as documented in nursing flowsheets. Time to withdrawal of life sustaining therapy was also abstracted for the cohort that did not awaken. Patients were excluded from analysis if they did not awaken or if they died for reasons other than WLST. Results: Twenty-eight percent of patients woke prior to hospital discharge and 43.4% underwent withdrawal of life sustaining therapy. Women made up 39.5% of the total cohort, 40% of the awakened cohort and 41% of the WLST cohort. Women had earlier day of awakening in comparison to men (day 2 (2, 4) vs. day 4 (2,5), p=0.0036), and also earlier time to WLST after ROSC than men (59 hours (26, 131) vs. 64 hours (22, 135), p=NS). Conclusion: In this single center cohort, there was a difference in time to awakening between men and women. How time to awakening might differ between the sexes with guideline concordant time to WLST is unknown. Further research is necessary to explore the role of therapeutic interventions and differing physiology between men and women as it applies to time to awakening.

Abstract 3: Impact Of Transport To Critical Care Centers Vs. Non-critical Care Hospitals On Outcomes From Out-of-hospital Cardiac Arrest In Osaka, Japan

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Kentaro Kajino ◽  
Taku Iwami ◽  
Mohamud Daya ◽  
Naohiro Yonemoto ◽  
Tatuya Nishiuchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Coronary Intervention ◽  
Primary Outcome Measure ◽  
Confounding Variables ◽  
Significant Difference ◽  
Stratified Analysis ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Better Than

Background: Recent studies suggest that specialized hospital care including hypothermia and early percutaneous coronary intervention (PCI) influences the outcome of out-of -hospital cardiac arrest (OHCA) patients. In Japan, selected hospitals are certificated as “Critical Care Centers (CCC)” based on their expertise and ability to provide these higher levels of care. We hypothesized that the outcomes of patients with OHCA who were transported to CCC is better than if they were transported to non-critical care hospitals (NCCH) in Osaka, Japan. Materials and Methods: All adults with OHCA of presumed cardiac etiology, treated by the emergency medical services (EMS) systems, and transported to a hospital in Osaka, Japan from January 1, 2005 to December 31, 2006 were studied using a prospective Utstein style population cohort database. Primary outcome measure was one month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCC were compared to patients transported to NCCH using multiple logistic regression to adjust for the following confounding variables; gender, age, witnessed status, bystander CPR, location, transport time and initial rhythm. We also performed a stratified analysis based on whether the patients achieved ROSC prior to arrival at the hospital. Results: Of 6,943 OHCA of presumed cardiac etiology, 6,706 cases were transported. Of these, 1,780 were transported to CCC while 4,926 were transported to NCCH. Neurologically favorable survival at one-month was greater in the CCC group [103 (5.8 %) versus 119 (2.4 %), p < 0.001]. Transportation to CCC was a significant predictor [OR = 1.7, 95% CI interval (1.3 – 2.4)] of neurologically favorable survival after adjustment for confounding variables. In the stratified analysis, the impact of the CCC was not significant difference in patients transported after field ROSC. [OR = 1.4, 95% CI interval (0.92 – 2.22)] On the other hand, the impact of the CCC was even greater in patients transported prior to field ROSC. [OR = 2.4, 95% CI interval (1.3 – 4.5)] Conclusions: The outcomes of patients with OHCA with or without field ROSC who were transported to Critical Care Centers was better than if they were transported to Non-Critical Care Hospitals.

Abstract 18700: Impact of Gender on Clinical Outcomes in Adults With In-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jonah Garry ◽  
Robert Nguyen ◽  
Elinor Schoenfeld ◽  
Sam Parnia ◽  
Jignesh Patel
Keyword(s):  
Cardiac Arrest ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Men And Women ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background: Despite numerous advances in the delivery of resuscitative care, in-hospital cardiac arrest (IHCA) continues to be associated with high morbidity and mortality. We sought to study the impact of gender on return of spontaneous circulation (ROSC) and survival to discharge in patients with IHCA. Methods: The study population included 255 consecutive patients who underwent ACLS-guided resuscitation from January 2012- December2013 for IHCA at an academic tertiary medical center. Baseline demographic, clinical, laboratory, and clinical outcome data were recorded. Outcomes of interest included presence of sustained ROSC (defined as ROSC > 20 minutes) and survival to discharge. Results: Of the 255 patients studied, 96 (37.6%) were women and 159 (62.4%) were men. No difference in age, race, or ethnicity was noted between men and women. Women were shorter (160cm vs 174cm, p<0.001) and had lower weight (78kg vs 89kg, p<0.001), but had a trend towards higher body mass index (31.4 kg/m2 vs 29.4kg/m2, p=0.087). Women had lower rates of peripheral vascular disease (15.6% vs 27.0%, p=0.035) and hyperlipidemia (26.4% vs 41.6%, p=0.017). Rates of other comorbidities, including cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke, diabetes mellitus, chronic kidney disease, and hypertension were similar in men and women. Clinical presentation of IHCA, in particular, the initial rhythm, location of IHCA, duration of cardiopulmonary resuscitation, and laboratory results at the time of IHCA was similar in both men and women. With respect to outcomes, women were noted to have a trend toward lower rates of sustained ROSC (45.8% vs 57.9%, p=0.062) but no difference in survival to discharge (22.9% vs 27.0%, p=0.464). In multivariate analysis, gender was not an independent predictor of sustained ROSC or survival to discharge. Conclusion: Gender is not independently predictive of ROSC or survival to discharge in adults with IHCA.

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