Out-of-hospital cardiac arrest

2021 ◽  
pp. 76-87
Author(s):  
Jerry P Nolan ◽  
Christian Hassager
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Medical Emergencies ◽  
Hospital Cardiac Arrest

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient's final neurological and cardiological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

Cardiopulmonary resuscitation and the post-cardiac arrest syndrome

2015 ◽  
Author(s):  
Jerry P Nolan
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Medical Emergencies ◽  
Post Cardiac Arrest Syndrome

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient’s final neurological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

Cardiopulmonary resuscitation and the post-cardiac arrest syndrome

2017 ◽  
Author(s):  
Jerry P Nolan
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Medical Emergencies ◽  
Post Cardiac Arrest Syndrome

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient’s final neurological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

Abstract 325: Characteristics and Outcomes of Hanging Induced Out-Of-Hospital Cardiac Arrest: Insights From the Paris Sudden Death Expertise Center Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Arnaud Gille ◽  
Richard Chocron ◽  
Anna Ozguler ◽  
Xavier JOUVEN ◽  
Alain Cariou ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Spontaneous Circulation ◽  
Low Flow ◽  
Flow Duration ◽  
Shockable Rhythm ◽  
Younger Age ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Hanging-induced Out-of-Hospital cardiac arrest (OHCA) is poorly studied and a better understanding of these specific OHCA could be helpful to improve patients’ outcome. The main objective of our study was to describe characteristics and outcomes in patients who had OHCA from hanging injuries. Methods: From May 2011 to December 2017 we analyzed a prospectively collected Utstein database for all OHCA adults. All cases due to hanging were included. Utstein style variables were compared for 2 groups of patients: those with a Return of Spontaneous Circulation (ROSC) and those without (non-ROSC). Continuous data are described as means (extremes). Results: Among 25 055 OHCA, 500 patients were included. They were 49 (18-100) years old. Seventy-three (14.6%) hanging were witnessed and 58 (11.6%) benefited from a bystander cardiopulmonary resuscitation before Emergency Medical Service (EMS) arrival. No-flow duration was 29.1 (4-180) minutes. Advance life support was initiated by EMS in 299 (59.8%) cases. Low-flow duration was 23.8 (2-79) minutes. Nine patients (1.8%) had a shockable initial rhythm. We observed 83 (16.6%) ROSC. Four (0.8%) patients were discharged alive from hospital. They were all CPC 1. Table 1 compares characteristics with significant differences between ROSC and non-ROSC groups. Conclusion: As expected, younger age, short no-flow and low-flow durations and shockable rhythm on EMS arrival were significantly associated with ROSC. Overall prognosis is dramatically poor when OHCA is due to hanging (<1%), with a very low proportion of shockable rhythm, even if the rare survivors have an excellent CPC at discharge. Indeed, the best method to reduce the mortality rate of hanging is, with no contest, the prevention of suicidal act.

Improving Survival After In-Hospital Cardiac Arrest: The Australian Experience

2007 ◽  
Vol 16 (3) ◽  
pp. 240-247 ◽  
Author(s):  
Robyn Peters ◽  
Mary Boyde
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
High Rate ◽  
Hospital Data ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Resuscitation Training ◽  
Hospital Cardiac Arrest

Background Survival rates after in-hospital cardiac arrest have not improved markedly despite improvements in technology and resuscitation training. Objectives To investigate clinical variables that influence return of spontaneous circulation and survival to discharge after in-hospital cardiac arrest. Methods An Utstein-style resuscitation template was implemented in a 750-bed hospital. Data on 158 events were collected from January 2004 through November 2004. Significant variables were analyzed by using a multiple logistic regression model. Results Of the 158 events, 128 were confirmed cardiac arrests. Return of spontaneous circulation occurred in 69 cases (54%), and the patient survived to discharge in 41 (32%). An initial shockable rhythm was present in 42 cases (33%), with a return of spontaneous circulation in 32 (76%) and survival to discharge in 24 (57%). An initial nonshockable rhythm was present in the remaining 86 cases (67%), with a return of spontaneous circulation in 37 (43%) and survival to discharge in 17 (20%). Witnessed or monitored arrests (P=.006), time to arrival of the cardiac arrest team (P=.002), afternoon shift (P=.02), and initial shockable rhythm (P=.005) were independently associated with return of spontaneous circulation. Location of patient in a critical care area (P=.002), initial shockable rhythm (P&lt;.001), and length of resuscitation (P=.02) were independently associated with survival to hospital discharge. Conclusions The high rate of survival to discharge after cardiac arrest is attributed to extensive education and the incorporation of semiautomatic external defibrillators into basic life support management.

scholarly journals Initial capnography values and resuscitation outcomes of patients assisted by basic life support units in first instance; descriptive prospective study

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Work Experience ◽  
Basic Life Support ◽  
Life Support ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Patient Treatment ◽  
Mean Values ◽  
Hospital Cardiac Arrest

Introduction: Understanding the key factors which affect out hospital cardiac arrest (OHCA) outcomes is essential in order to promote patient treatment. The main objective of this research was to describe the correlations between the capnographic values obtained during the first minute of monitoring on cardiopulmonary resuscitation, assisted by basic life-support units, with the results as return of spontaneous circulation (ROSC) and alive hospital admission. The secondary objectives were to describe the sociodemographic characteristics of the patients assisted, and to analyze any correlations between receiving basic life-support units and/or defibrillation prior to the arrival of basic life-support units, and the results of the cardiopulmonary resuscitation maneuvers. Methods: A prospective, descriptive, observational study of adult non-traumatic out hospital cardiac arrest patients was conducted. The patients were initially assisted by basic life-support units on the island of Mallorca, with one minute of initial capnography monitoring. Results: From July 2018 to March 2020, fifty-nine patients meeting the inclusion criteria were assisted, 76% were men and their mean age was 64.45 (±15.07) years old. The number of emergency lifesaving technicians who participated in the study was 58, they had a mean work experience of 14.05 (±6.7) years. Thirty-seven (63.7%) patients underwent basic life-support by bystanders and in 91.5% of cases the semi-automatic external defibrillator was used. Capnometry values during the first minute were obtained in 34 (58.6%) patients, their mean values were 22 (±19.07) mmHg, 35.5% of patients had values <10 mmHg. In 25.4% of the patients, spontaneous circulation returned during cardiopulmonary resuscitation, and 18.6% were admitted to hospital alive. Conclusion: No correlations were found between initial capnography values scoring above or below 10 mmHg and survival, however, basic life-support maneuvers, and defibrillation by bystanders and first responders, did correlate with survival rates. The average patient assisted in out of hospital cardiac arrest by the basic life-support units sampled was an adult male aged over 65 years.

Abstract 125: "Load & Go" Criteria in Out-of-Hospital Cardiac Arrest Patients for the Use of Emergency-Extracorporal Life Support at the Emergency Department

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael Poppe ◽  
Andreas Schober ◽  
Christoph Weiser ◽  
Patrick Sulzgruber ◽  
Philip Datler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Basic Life Support ◽  
Life Support ◽  
Final Analysis ◽  
Spontaneous Circulation ◽  
Emergency Physicians ◽  
Return Of Spontaneous Circulation ◽  
Utstein Style ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: The outcome of patients after OHCA has been poor. The probability of return of spontaneous circulation decreases over time. New therapeutic attempts like E-ECLS at the ED are tried to improve outcome of selected cases. The "Vienna Cardiac Arrest Registry" (VICAR) was introduced August 1, 2013 to collect Utstein-style data. Our aim was to identify those patients which might fulfill ‘load&go’ criteria for E-ECLS at the ED after OHCA. Methods: Therefore VICAR was retrospectively analysed for following criteria: age<75a;witnessed OHCA; basic life support (BLS); ventricular fibrillation/ventricular tachycardia (VF/VT); no return of spontaneous circulation (ROSC) within 15min CPR by EMS. Patients had to fulfill all these criteria. Results: Overall 701 patients were registered from August 1, 2013 to April 30, 2014. Excluded were because of poor documentation 26(4%) patients, because of missing criteria data 49(7%) and because they were younger than 18 years 7 (1%). The final analysis included 619(88%) patients; of those 68(11%) were transported under ongoing CPR to the ED. Moreover E-ECLS was applied in 15 patients at the ED. Conclusion: We found 30 (5%) patients to fulfill ’load & go’ criteria. Of 68 patients, who were transported with ongoing CPR to the ED only 8 (8%) met the criteria. Further promotion of these criteria within the ambulance crews is needed. Maybe these criteria could then serve as a decision support for emergency physicians/paramedics, which patients to transport under ongoing CPR to the ED for E-ECLS.

Abstract 109: Automated External Defibrillators Are Rarely Used for In-Hospital Cardiac Arrest in Denmark

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mathilde Staerk ◽  
Kasper G Lauridsen ◽  
Kristian Krogh ◽  
Hans Kirkegaard ◽  
Bo Løfgren
Keyword(s):  
Cardiac Arrest ◽  
Hospital Setting ◽  
Spontaneous Circulation ◽  
Early Defibrillation ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Rhythm Analysis ◽  
Hospital Cardiac Arrest ◽  
Cardiac Arrest Team

Introduction: Automated External Defibrillators (AEDs) are widely distributed in the pre-hospital setting and reported to reduce time to defibrillation and increase survival from out-of-hospital cardiac arrest. During in-hospital cardiac arrest (IHCA), AEDs may allow for early defibrillation before the cardiac arrest team arrives with a manual defibrillator. However, the effect of AEDs for IHCA remains unclear. This study aimed to investigate AED usage and contribution to defibrillation before cardiac arrest team arrival during IHCA. Methods: We obtained data on IHCAs in 2016 and 2017 from the Danish nationwide registry on IHCA (DANARREST). Data included information on initial rhythm, type of defibrillator, time to first rhythm analysis, time to arrival of the cardiac arrest team, time to first defibrillation, and return of spontaneous circulation (ROSC). Results: Of 4,496 IHCAs, AEDs were used in 421 resuscitation attempts (9%). Time registrations were excluded for 6 non-shockable IHCAs due to errors in registration. Of the 421 IHCAs, 82% (n=347) were non-shockable and 16% (n=68) were shockable (data missing for 6 IHCAs). ROSC was achieved in 46% (n=158) of patients with non-shockable rhythms and 59% (n=40) of patients with shockable rhythms. For IHCAs with a shockable rhythm and usage of an AED, rhythm analysis was performed before arrival of the cardiac arrest team in 50% (n=34) of cases and defibrillation with an AED were performed in 46% (n=27) of the cases. Patients with shockable rhythms defibrillated before arrival of the cardiac team, more often achieved ROSC compared to patients defibrillated after cardiac arrest team arrival (p=0.0024). Data regarding time registration are shown in the table. Conclusion: AEDs are used in approximately 1 of 10 resuscitation attempts in Danish hospitals and contribute to defibrillation before arrival of the cardiac arrest team in 1 of 14 cardiac arrest patients.

Abstract 75: Ventricular Fibrillation in Cardiac Arrest with Nonshockable Initial Rhythm

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fernando Rosell-Ortiz ◽  
Francisco J Mellado-Vergel ◽  
Patricia Fernández-Valle ◽  
Auxiliadora Caballero-García ◽  
Ismael González-Lobato ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Neurological Status ◽  
Good Prognosis ◽  
Spontaneous Circulation ◽  
Emergency Team ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Prognostic Group ◽  
Hospital Cardiac Arrest

The initial shockable rhythm in cardiac arrest is a well known factor of good prognosis. Little is known about the influence of the onset of ventricular fibrillation during resuscitation at cardiac arrest whose initial rhythm was non-shockable. Methods: Retrospective analysis of a continuous registry of out-of-hospital cardiac arrest (OHCA) Inclusion criteria, all consecutive patients suffering OHCA attended by emergency teams in Andalusia, Spain. Period January 2008 - December 2012. Results: 5067 patients were included. According to the initial cardiac arrest rhythm 1038 (20.5%) cases presented initial shockable rhythm (SR) and 4029 (79.5%) with non-shockable initial rhythm (NSR). Of these patients 150 (3%) reported one or more episodes of ventricular fibrillation during resuscitation (NSRVF). The main clinical characteristics of these three groups are shown in Table 1. Variables associated with good neurological status at hospital discharge are shown in Table 2. Conclusions: NSRVF patients present higher survival with good neurological status than NSR patients. These patients may represent a third prognostic group in cardiac arrest with a survival rate between shockable and non-shockable initial rhythms. Table 1. Clinical data of patients regarding rhythm of cardiac arrest Table 2. Variables associated with good neurological status at discharge (CPC 1-2 ) SD: Standard deviation. IQR: Interquartile range. OR: Odds Ratio. CI: Confidence Interval. ET: Emergency Team. VF: Ventricular Fibrillation. CPR: Cardiopulmonary resuscitation. CPC: Cerebral Perfomance Category. ROSC: Return of spontaneous circulation

Abstract 234: Validation of a Termination-of-resuscitation Rule for Patients with Refractory Out-of-hospital Cardiac Arrest at an Emergency Department in Japan

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Masayuki Takamura
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Medical Service ◽  
Basic Life Support ◽  
Life Support ◽  
High Specificity ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Using Data ◽  
Hospital Cardiac Arrest

Introduction: In Japan, emergency medical service (EMS) providers are prohibited from cardiopulmonary resuscitation (CPR) termination in the field and must transport all out-of-hospital cardiac arrest (OHCA) patients to a hospital, regardless of the return of spontaneous circulation (ROSC). We previously developed a termination of resuscitation (TOR) rule for emergency department physicians (ED-TOR) treating OHCA patients using data from the All-Japan Utstein Registry between 2005 and 2009, when CPR was performed according to the 2005 guidelines. The ED-TOR rule recommends CPR termination when patients in the emergency department meet all of the following criteria: initial unshockable rhythm, arrest unwitnessed by bystanders and no prehospital ROSC. Hypothesis: We aimed to validate the ED-TOR rule using more recent data, where CPR was performed according to the 2010 and 2015 guidelines, comparing the relevance of the ED-TOR rule with the universal basic life support TOR (BLS-TOR) rule, which consists of the following criteria: no prehospital ROSC, unwitnessed arrest by EMS providers and no shock received. Methods: We analysed 552,554 OHCA patients (age ≥ 18 years) treated by EMS providers. OHCA patients witnessed by EMS providers were excluded. Data were obtained from a prospectively recorded All-Japan Utstein Registry from 2013 to 2017. The study endpoints were specificity and a positive predictive value (PPV) for predicting 1-month mortality after OHCA with the ED-TOR and BLS-TOR rules. Results: The overall 1-month survival rate was 4.3% (23,733/552,554). The proportions of OHCA patients who fulfilled the ED-TOR and BLS-TOR criteria were 59.6% and 83.8%, respectively. The specificity and PPV of the ED-TOR and BLS-TOR rules for predicting 1-month mortality were 93.2% (95% confidence interval [CI], 92.8%-93.5%) and 99.5% (95% CI, 99.5%-99.5%) and 82.6% (95% CI, 82.1%-83.1%) and 99.1% (95% CI, 99.1%-99.1%), respectively. Conclusions: The ED-TOR rule was successfully validated using more recent data from a Japanese registry where CPR was performed according to the 2010 and 2015 guidelines. The ED-TOR rule was slightly superior to the BLS-TOR rule in Japanese EMS systems showing high specificity and PPV for predicting 1-month mortality.

Abstract 101: Top Quality of Ventilation During Out-of-Hospital Cardiac Arrest Is Hard to Reach

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Philip Datler ◽  
Patrick Sulzgruber ◽  
Michael Poppe ◽  
Markus Keferböck ◽  
Sebastian Zeiner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Ventilation Rate ◽  
Spontaneous Circulation ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Feedback Form ◽  
Hospital Cardiac Arrest

INTRODUCTION: With an incidence of ~45patients with out-of hospital cardiac arrest (OHCA) /100.000 inhabitants per year and thus over 700 cases annually, but a survival rate as low as 10%, OHCA remains still a challenge the chain of survival. Recently ventilation has gained less importance for BLS and thus the question arises, if this attitude was mirrored during ALS measures provided by ambulance crews. Therefore our analysis assessed the quality of ventilation during out of hospital cardiac arrests. METHODS: Over a period of 9 months, from August 1st 2013 until April 30th 2014, all patients suffering from an OHCA, aged 18 years and above and treated by the emergency medical service crews in Vienna, Austria were included in this study. A collective of 701 consecutive cases have been analyzed using the ECG- and impedance data recorded by the defibrillators used. On the basis of this data, the abidance of the quality standards of ventilation was examined using the current guidelines of the European Resuscitation Council of 2010 as gold standard. After the evaluation of each case, the responding EMS-teams were informed about the quality of the resuscitation via a feedback form. RESULTS: Endotracheal intubation was accomplished in 338 patients (47%). Ventilation was performed in accordance to the ERC guidelines in 49% (CI: 46-52) of total recorded ventilation minutes. Patients who had restoration of spontaneous circulation (ROSC) (n=135) after being intubated were ventilated with 9 (CI: 9-11; variance: 11) ventilations per minute. In patients not achieving ROSC (n=203) 10 (CI: 9-11; variance: 25) ventilations per minute were administered. Patients that were ventilated with a supraglottic airway device or a bag valve and mask received 6(SD±4) ventilations per minute. CONCLUSION: The high ventilation rate standard deviations within the compliance to guidelines suggest that there are numerous cases in which ventilation standards are not met. Therefore further analysis will be necessary to find out, what influence this might have on outcome and if it will be necessary to put more emphasis in upcoming discussions on the quality of ventilation at least during advanced life support.

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