scholarly journals Association of subsequent shock after conversion to shockable rhythm with outcomes stratified by the type of initial non-shockable rhythm in children with out-of-hospital cardiac arrest

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Significance ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Delivery Time ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research) Background/Introduction: The rhythm conversion from initial non-shockable to shockable rhythm during cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) providers may be associated with neurologically intact survival after out-of-hospital cardiac arrest (OHCA) in children with an initial non-shockable rhythm. However, the prognostic significance of rhythm conversion stratified by the type of initial non-shockable rhythm is still unclear. Purpose We aimed to investigate the association of subsequent shock after rhythm conversion to shockable rhythm with neurologically intact survival and shock delivery time (time from EMS-initiated CPR to first shock delivery) by the type of initial non-shockable rhythm in children with OHCA. Methods We analysed the records of 19,095 children (age <18 years) with OHCA treated by EMS providers. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 13-year period (2005–2017). The primary outcome measure was 1-month neurologically intact survival, defined as cerebral performance category score of 1 to 2. Patients were divided into the initial pulseless electrical activity (PEA) (n = 3,326 [17.4%]) and initial asystole (n = 15,769 [82.6%]) groups. Results The proportion of patients who received subsequent shock after conversion to shockable rhythm was significantly higher in the initial PEA than in the initial asystole groups (3.3% [109/3,326] vs. 1.4% [227/15,769], p < 0.0001). The shock delivery time was significantly shorter in the initial PEA than in the initial asystole groups (median [IQR], 8 min [5 min – 12 min] vs. 10 min [6 min – 16 min], p < 0.01). Among the initial PEA patients, there was no significant difference between subsequently shocked (10.0% [11/109]) and subsequently non-shocked patients (6.0% [192/3,217], p = 0.10) regarding the rate of 1-month neurologically intact survival. However, after adjusting for 9 pre-hospital variables, subsequent shock with a delivery time of <10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.16–5.16], p = 0.018). Among the initial asystole patients, the rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked (4.4% [10/227]) than in the subsequently non-shocked (0.7% [106/15,542], p < 0.0001). A multivariate logistic regression model showed that subsequent shock with a delivery time of <10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted OR, 9.77 [95% CI, 4.2–22.5], p < 0.0001). Conclusions In children with OHCA with an initial non-shockable rhythm, subsequent shock after conversion to shockable rhythm during CPR was associated with increased odds of 1-month neurologically intact survival only when shock was delivered <10 min from EMS-initiated CPR regardless of the type of initial rhythm.

scholarly journals Subsequent shock delivery and outcomes in out-of-hospital cardiac arrests with initial unshockable rhythm

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
Y Goto
Keyword(s):  
Prognostic Significance ◽  
Pulseless Electrical Activity ◽  
Multivariate Logistic Regression Model ◽  
Delivery Time ◽  
Crude Rate ◽  
Shock Delivery ◽  
National Budget ◽  
Shockable Rhythm ◽  
Public Grant ◽  
Neurologically Intact

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research) Background The conversion from initial non-shockable to shockable rhythms during cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers may be associated with neurologically intact survival after out-of-hospital cardiac arrest (OHCA). However, the prognostic significance of rhythm conversion according to the type of initial nonshockable rhythm is unclear. Purpose To determine the association between shock after conversion to shockable rhythm with neurologically intact survival after OHCA and shock delivery time (time from EMS-initiated CPR to first shock delivery) in patients with two types of initial unshockable rhythm. Methods We analyzed the records of 90,334 adult patients with witnessed OHCA of cardiac origin who were treated by EMS providers and had an initial unshockable rhythm. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 5-year period (2013–2017). The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance categories score from 1 to 2. Patients were divided into initial pulseless electrical activity (PEA) (n = 37,977 [42.0%]) and initial asystole (n = 52,357 [58.0%]) groups. Results In the initial PEA group, the crude rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked than in the non-shocked patients (4.2% [121/2,896]) vs. 2.4% [857/35,081], p <0.0001). After adjustment for ten prehospital variables, the adjusted odds ratios (aORs) of subsequent shock for 1-month neurologically intact survival compared to no shock delivery were as follows: shock delivery time <10 min, 2.21 (95% confidence interval [CI], 1.77–2.77, p< 0.0001); 10–14 min, 1.43 (0.89–2.28, p = 0.14); and ≥15 min, 0.36 (0.16–0.81; p = 0.013). In the initial asystole group, the crude rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked than in the non-shocked (1.7% [47/2,687] vs. 0.4% [203/49,670], p <0.0001). A multivariate logistic regression model showed that subsequent shock with a shock delivery time <10 min was associated with increased odds of neurologically intact survival compared to no shock delivery (aOR, 5.67; 95% CI, 3.92–8.18; p <0.0001). However, there were no significant differences in neurological outcomes between subsequently shocked and non-shocked patients when the shock delivery time was 10–14 min (p = 0.21) or ≥15 min (p = 0.91). Conclusions In patients with witnessed OHCA of cardiac origin and initial nonshockable rhythm, subsequent shock after conversion to shockable rhythm during CPR was associated with increased odds of 1-month neurologically intact survival only when shock was delivered <10 min from EMS-initiated CPR, regardless of the type of initial rhythm. Further, in patients with initial PEA, subsequent shock was associated with decreased odds of neurologically intact survival when shock was delivered ≥15 min from EMS-initiated CPR.

P492Estimation of no-flow duration and survival in patients with an initial shockable rhythm after out-of-hospital cardiac arrest

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
F Okada ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Flow Duration ◽  
Shockable Rhythm ◽  
Number Of Patients ◽  
Initial Rhythm ◽  
The Relationship ◽  
Neurologically Intact ◽  
Utstein Style ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999) Background In patients with unwitnessed out-of-hospital cardiac arrest (OHCA), the actual no-flow duration (the time with no organ perfusion) is unclear. However, when these patients have a shockable rhythm as an initial recorded rhythm, the no-flow duration may be relatively short as compared with other initial rhythms, and some patients can obtain a good functional outcome after OHCA. Purpose The purpose of the present study was to estimate the no-flow duration and to determine the relationship between no-flow duration and neurologically intact survival in patients with an initial shockable rhythm after OHCA. Methods We reviewed 82,464 patients with OHCA (aged ≥18 years, non-traumatic, witnessed, and without any bystander interventions) who were included in the All-Japan Utstein-style registry from 2013 to 2017. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). No-flow duration was defined as the time from emergency call to emergency medical services (EMS) arrival at the patient site. Results The rate of 1-month neurologically intact survival in the patients with an initial shockable rhythm (n = 10,384, 12.6% of overall patients) was 16.5% (1718/10,384). No-flow duration was significantly and inversely associated with 1-month neurologically intact survival (adjusted odds ratios for 1-minute increments: 0.85, 95% confidence interval: 0.84–0.86). The proportion of patients with a shockable rhythm to the overall patients (y, %) had a high correlational relationship with no-flow duration (x, min), depicted by y = 21.0 - 0.95 × x, R² = 0.935. In this analytical model, the number of patients with shockable rhythm reached null at 22 minutes of no-flow duration. The no-flow durations, beyond which the chance for initial shockable rhythm diminished to <10%, <5%, and <1%, were 12, 13, and 17 minutes, respectively. The rate of neurologically intact survival in the patients with shockable rhythm (y, %) and no-flow duration (x, min) were also found to have a strong correlation, depicted by y = 0.16 × x² - 5.12 × x + 45.0, R² = 0.907. The no-flow durations, beyond which the chance for 1-month neurologically intact survival diminished to <10%, <5%, and <1%, were 10, 11, and 15 minutes, respectively. Conclusions In OHCA patients without any bystander interventions before EMS personnel arrival, when a shockable rhythm is recorded by EMS personnel as an initial rhythm, the no-flow duration after cardiac arrest is highly likely to be <17 minutes regardless of the layperson witness status. The limitation of no-flow duration to obtain a 1-month neurologically intact survival after OHCA may be 15 minutes when the patients have an initial shockable rhythm.

Abstract 123: Field Accuracy of Paramedic Shock Delivery Using a Filtered ECG Rhythm

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Hill Stoecklein ◽  
Andrew Pugh ◽  
Michael Stroud ◽  
Scott Youngquist
Keyword(s):  
Cardiac Arrest ◽  
Salt Lake ◽  
Survival Rates ◽  
Salt Lake City ◽  
Fire Department ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Lake City ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Introduction: Recognition and rapid defibrillation of shockable rhythms is strongly associated with increased survival from out-of-hospital cardiac arrest (OHCA). The Salt Lake City Fire Department (SLCFD) adopted ECG rhythm filtering technology in 2011, along with a protocol to rapidly defibrillate shockable rhythms without awaiting the end of the 2-minute CPR epoch. Paramedics were also trained to empirically shock asystole, as studies have shown poor agreement in cases of fine and moderate amplitude Ventricular Fibrillation (VF). Hypothesis: We hypothesized that the mandate to shock perceived asystole plus the use of filtering technology would result in high case sensitivity for shockable rhythms at the expense of an unknown frequency of shock delivery to organized rhythms. Methods: Prospectively collected defibrillator data from cardiac arrest cases treated by SLCFD between Dec 2011 and June 2019 were analyzed. Timing of rhythm changes and defibrillation events was manually abstracted using the manufacturer’s review software. The gold standard for rhythm interpretation was post-incident physician interpretation. Results: Paramedics attempted resuscitation in 942 OHCAs. We excluded 41 pediatric cases, 140 cases of BLS or bystander-only AED resuscitation, and 65 cases in which the defibrillator file was unavailable. Overall, 696 adult cardiac arrests with 1,389 shocks delivered were available for analysis. Shocks were delivered to 958 (69%) shockable, 261 (19%) asystole, 158 (11%) PEA, 4 (0.3%) SVT, and 8 (0.6%) unknown underlying rhythms. In 280 cases no shock was delivered despite an initial shockable rhythm in 3 of these cases. Shock delivery case sensitivity was 180/183 (0.98, 95% confidence interval [CI]:0.97-1.0) with false positive proportion of delivered shocks of 158/1,389 (0.11, 95% CI:0.10-0.13) for PEA only and 419/1,389 (0.30, 95% CI:0.28-0.33) for combined PEA and asystole. Neurologically intact (CPC 1-2) overall and Utstein survival rates were 15% and 46% respectively. Conclusions: Using ECG rhythm-filtering technology and an aggressive protocol to defibrillate VF and empirically shock asystole, we demonstrated high case sensitivity for VF at the expense of an 11% rate of shock delivery to underlying PEA.

Abstract 9114: Impact of the Number of Prehospital Defibrillation Attempts on Neurologically Intact Survival in Patients With Out-of-Hospital Cardiac Arrest and Shockable Rhythm

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Kazuya Tateishi ◽  
Yuichi Saito ◽  
Hideki Kitahara ◽  
Yoshio Tahara ◽  
Naohiro Yonemoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Vascular Disease ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Cerebral Vascular Disease ◽  
Shockable Rhythm ◽  
Early Return ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest ◽  
Cerebral Vascular

Background: Early return of spontaneous circulation (ROSC) leads to survival with a favorable neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA). For the early ROSC, defibrillation plays a crucial role for OHCA with shockable rhythm. However, little is known about the relation between the number of prehospital defibrillation attempts or etiology of OHCA and neurologically intact survival. Methods: Using a nationwide OHCA registry database from 2005 to 2017 in Japan, a cohort of 1,527,447 patients with OHCA were retrospectively analyzed. We included the patients of witnessed OHCAs with initial shockable rhythm. The relation between early ROSC, defined as prehospital ROSC achieved with defibrillation ≤3 times without adrenaline, and a neurologically intact survival rate (cerebral performance category score of 1 or 2 at 1 month) was evaluated. We also analyzed factors related to the successful early ROSC, including etiology of OHCA. Results: A total of 75,342 patients were included. Among patients with OHCA and prehospital ROSC, neurologically intact survival rates were better in patients who achieved early ROSC than their counterpart (62% vs. 36%, p<0.001). Success in early ROSC was an independent predictor of neurologically intact survival after adjustment of multiple cofounders (Table). Multivariate analysis showed cerebral vascular disease as an etiology of OHCA was a predictor of early ROSC (odds ratio 1.15, 95% confidence interval 1.03-1.29, p=0.02), but was significantly associated with a poor neurologic outcome at 1 month (Table). Conclusions: Success in early ROSC was associated with neurologically intact survival in patients with OHCA and initial shockable rhythm. Patients with OHCA due to cerebral vascular disease were likely to be resuscitated from cardiac arrest by defibrillations but had a poor neurologic outcome.

Abstract 144: Good Neurological Survival After Cardiac Arrest with Initial Shockable Rhythm Increased Year by Year but with Unshockable Rhythm Did Not in Japan

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroyuki Hanada ◽  
Hiroshi Nonogi ◽  
Ken Nagao
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Population Based ◽  
Performance Category ◽  
Shockable Rhythm ◽  
Rate Of Increase ◽  
New Strategy ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Backgrounds: Early good cardiopulmonary resuscitation (CPR) and early defibrillation are essential for good neurological survival (GNS) in out-of-hospital cardiac arrest (OHCA). Both automated external defibrillator (AED) equipped in public place and CPR educated people in Japan have been increased. We hypothesized that GNS in patients resuscitated from initial shockable rhythm have been increasing in Japan and that GNS from initial unshockable rhythm might not. Methods and Results: From January 2005 through December 2012, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n= 925,288). We identified 73,751 witnessed cardiogenic cardiac arrest with the age >18 years old and transported to hospitals within 60 minutes from the witness. Among them, 18,436 cases had the initial shockable rhythm of ventricular fibrillation (VF) or pulsless ventricular tachycardia (VT) and 55,315 cases had the initial unshockable rhythm of pulseless electrical activity (PEA) or asystole (Asys). GNS was defined as cerebral performance category scale 1 or 2 one month after the arrest. Results were shown in the figure. Although the rate of increase in number of OHCA with unshockable arrest over the year was greater than that with shockable arrest, GNS ratio was increasing only in OHCA with shockable arrest. Conclusion: Good neurological survival resuscitated from initial arrest rhythm with VF/VT had been increasing year by year, but that with PEA/Asys was very low and not changed these 8 years in Japan. We need new strategy for those OHCA patients with initial unshockable rhythm.

scholarly journals LO03: Impact of the conversion to a shockable rhythm from a non-shockable rhythm for patients suffering from out-of-hospital cardiac arrest

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S7-S7
Author(s):  
A. Cournoyer ◽  
E. Notebaert ◽  
S. Cossette ◽  
J. Morris ◽  
L. de Montigny ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Outcome Measure ◽  
Prognostic Significance ◽  
Pulseless Electrical Activity ◽  
Primary Outcome Measure ◽  
Absolute Difference ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) with an initial shockable rhythm (ventricular tachycardia or ventricular fibrillation) have higher odds of survival than those suffering from non-shockable rhythm (asystole or pulseless electrical activity). Because of that prognostic significance, patients with an initial non-shockable rhythm are often not considered for advanced resuscitation therapies such as extracorporeal resuscitation. However, the prognostic significance of the conversion to a shockable rhythm from an initially non-shockable rhythm remains uncertain. This study aimed to determine the degree of association between the conversion (or not) of a non-shockable rhythm to a shockable rhythm and resuscitation outcomes in patients with OHCA. It was hypothesized that such a conversion would be associated with a higher survival to discharge. Methods: The present study used a registry of adult OHCA between 2010 and 2015 in Montreal, Canada. Adult patients with non-traumatic OHCA and an initial non-shockable rhythm were included. The primary outcome measure was survival to hospital discharge, and the secondary outcome measure was prehospital return of spontaneous circulation (ROSC). The associations of interest were evaluated with univariate logistic regressions and multivariate models controlling for demographic and clinical variables (e.g. age, gender, type of initial non-shockable rhythm, witnessed arrest, bystander cardiopulmonary resuscitation). Assuming a survival rate of 3% and 25% of the variability explained by the control variables, including more than 4580 patients would allow to detect an absolute difference of 4% in survival between both groups with a power of more than 90%. Results: A total of 4893 patients (2869 men and 2024 women) with a mean age of 70 years (standard deviation 17) were included, of whom 450 (9.2%) experienced a conversion to a shockable rhythm during the course of their prehospital resuscitation. Among all patients, 146 patients (3.0%) survived to discharge and 633 (12.9%) experienced prehospital ROSC. In the univariate models, there was no association between the conversion to a shockable rhythm and survival (odds ratio [OR] 1.14 [95% confidence interval {CI} 0.66-1.95]), but a significant assocation was observed with ROSC (OR 2.00 [95% CI 1.57-2.55], p<0.001). However, there was no independent association between the conversion to a shockable rhythm and survival (adjusted OR [AOR] 0.92 [95% CI 0.51-1.66], p=0.78) and prehospital ROSC (AOR 1.30 [95% CI 0.98-1.72], p=0.073). Conclusion: There is no clinically significant association between the conversion to a shockable rhythm and resuscitation outcomes in patients suffering from OHCA. The initial rhythm remains a much better outcome predictor than subsequent rhythms and should be preferred when evaluating the eligibility for advanced resuscitation procedures.

Abstract 9502: Prehospital Variables Associated With Neurologically Intact Survival in Elderly Survivors After Out-of-Hospital Cardiac Arrest: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Masayuki Takamura
Keyword(s):  
Cardiac Arrest ◽  
Service Providers ◽  
Recursive Partitioning ◽  
Age Groups ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Population Based ◽  
Shockable Rhythm ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Introduction: Prehospital variables associated with neurologically intact survival in elderly survivors after out-of-hospital cardiac arrest (OHCA) are unclear and could differ according to age. Methods: We evaluated 6,349 elderly patients with OHCA (age ≥ 65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC) and survived for at least 1-month after OHCA. Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients were divided into three groups by age (65-74, 75-89, or ≥ 90 years). The time from call receipt to ROSC was calculated. Results: The rates of 1-month CPC 1-2 in patients aged 65-74, 75-89, and ≥ 90 years were 66.5% (2,079/3,125), 52.9% (1,557/2,943), and 42.7% (120/281), respectively (p for trend < 0.001). In multivariate logistic regression analysis, initial shockable rhythm and witnessed arrest were significantly associated with 1-month CPC 1-2 for all age groups (Table). However, the presence of bystander cardiopulmonary resuscitation (CPR) was significantly associated with 1-month CPC 1-2 only for patients aged 65-74 years. Time from call receipt to ROSC was not associated with 1-month CPC 1-2 for patients aged ≥ 90 years. In recursive partitioning analysis, the best single predictor for 1-month CPC 1-2 was initial shockable rhythm for all age groups. The next predictor for patients aged 65-74 years with initial shockable rhythm was the presence of bystander CPR, whereas the witnessed arrest was the next predictor for patients aged 65-74 years with initial non-shockable rhythm and other age groups regardless of the initial rhythm. Conclusions: Prehospital variables associated with neurologically intact survival in elderly survivors after OHCA varied with age.

Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Furqan B Irfan ◽  
Zain A Bhutta ◽  
Tooba Tariq ◽  
Loua A Shaikh ◽  
Pregalathan Govender ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Incidence Rate ◽  
Hospital Discharge ◽  
Middle Eastern ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Final Analysis ◽  
National Registry ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Markus Keferböck ◽  
Philip Datler ◽  
Mario Krammel ◽  
Elisabeth Lobmeyer ◽  
Alexander Nürnberger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Sudden Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Medical Personnel ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

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