Positive Findings on Long-Term Neurological Outcome for Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 11 (19) ◽  
pp. 28-29
Author(s):  
Mark Moran
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract 305: German Resuscitation Registry Influence of Age on Short and Long-Term Outcome After Out-of-Hospital Cardiac Arrest or Should We Resuscitate the Elderly?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Stephan Seewald ◽  
Jan Wnent ◽  
Barbara Jakisch ◽  
Andreas Bohn ◽  
Matthias Fischer ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
The Elderly ◽  
Good Neurological Outcome ◽  
Term Survival ◽  
Long Term Survival ◽  
Shockable Rhythm ◽  
Short And Long Term ◽  
Hospital Cardiac Arrest

Introduction: Cardiac arrest is a common event and one of the leading causes of death. Especially within the elderly judgment on if the treatment will be in favor of the patient is a major challenge for the medical team. We evaluated the influence of the age on short and long-term survival after out-of- hospital cardiac arrest (OHCA). Hypothesis: Elderly people survive an out-of-hospital cardiac arrest with good neurological outcome. Methods: For this purpose, we analyzed data of 24,686 out-of-hospital cardiac arrest patients prospectively registered between 2008 and 2017 within the German Resuscitation Registry (GRR). The data records were divided according to different age groups and within the age group after shockable and non-shockable rhythms. The data sets were examined with regard to short and long-term survival. Short term survival was measured by expected and observed return-of-spontaneous circulation based on the RACA-score. The RACA-score is a previously published score to predict ROSC based on readily available variables after arrival of the emergency medical service (EMS) on scene. Long-term survival was differentiated in 24-hour survival, 30-day survival and hospital discharge with good neurological outcome (Cerebral Performance Category 1 and 2). Results: (Table 1) Conclusions: Our data shows that shockable rhythm and younger age are important factors of good neurological outcome after OHCA. Nevertheless, the few cases with shockable rhythms (411 out of 3227) in the elderly (>85 years) showed a favorable neurological outcome in 12.2% (77,2% of all patients with hospital discharge). In the non-shockable group 1.4% (58,3%) of the >85 year old had a good outcome. Data show that a resuscitation attempt in the elderly is not futile, especially if a shockable rhythm is detected. Further studies are necessary to maintain this decision.

Abstract 352: Predictive Value of Discharge Neurological Outcome Scores Following Out-of-Hospital Cardiac Arrest for Long-term Neurological Status: A Systematic Review

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Wen Yu Wu ◽  
Amit Chopra ◽  
Shelley McLeod ◽  
Carolyn Ziegler ◽  
Steve Lin
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Observational Studies ◽  
Neurological Status ◽  
Short Term ◽  
Outcome Scores ◽  
Hospital Cardiac Arrest

Introduction: Neurological outcomes following out-of-hospital cardiac arrest are commonly assessed using clinically validated outcome measures such as the Cerebral Performance Category (CPC) score, and are mainstay for evaluating neurological status at discharge. However, it remains unclear if these measures accurately reflect long-term neurological status after discharge. The primary objective of this systematic review was to better understand the predictive value of discharge neurological outcome scores for long-term neurological status. Methods: Comprehensive electronic searches of Medline, Embase and The Cochrane Library from inception to September 2016 were conducted and reference lists were hand-searched.Randomized controlled trials (RCT) and prospective observational studies were included. Our primary outcome was the correlation between discharge or 30 days post-arrest neurologic status and long-term ( > 3 month) neurological outcome score. Preliminary Results: After screening 4,265 titles and abstracts independently and in duplicate, 6 studies including 5 prospective observational studies and 1 RCT were included. Four studies reported long-term follow-up at 6 months post-arrest and 2 studies reported follow-up at 1 year. In the studies with 6-month follow-up, 368/450 patients (82.7%) had favourable short-term neurological scores (CPC 1-2) at discharge or 30 days post-arrest, and 352/445 patients (79.1%) had favourable scores at 6 months post-arrest. In the studies with 1-year follow-up, 67/80 patients (83.8%) had favourable neurological scores at discharge or 30 days post-arrest, and 60/80 patients (75%) patients had favourable neurological scores at 1 year. Conclusion: Long-term neurological outcome scores following OHCA were consistent with short-term outcome at hospital discharge or 30 days post-arrest. Further studies are needed to elucidate more comprehensive prognostic factors for predicting long-term neurological outcome.

Trimethylamine-N-oxide (TMAO) predicts short- and long-term mortality and poor neurological outcome in out-of-hospital cardiac arrest patients

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Seraina R. Hochstrasser ◽  
Kerstin Metzger ◽  
Alessia M. Vincent ◽  
Christoph Becker ◽  
Annalena K. J. Keller ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Nutritional Interventions ◽  
Poor Neurological Outcome ◽  
Short And Long Term ◽  
Hospital Cardiac Arrest

AbstractObjectivesPrior research found the gut microbiota-dependent and pro-atherogenic molecule trimethylamine-N-oxide (TMAO) to be associated with cardiovascular events as well as all-cause mortality in different patient populations with cardiovascular disease. Our aim was to investigate the prognostic value of TMAO regarding clinical outcomes in patients after out-of-hospital cardiac arrest (OHCA).MethodsWe included consecutive OHCA patients upon intensive care unit admission into this prospective observational study between October 2012 and May 2016. We studied associations of admission serum TMAO with in-hospital mortality (primary endpoint), 90-day mortality and neurological outcome defined by the Cerebral Performance Category (CPC) scale.ResultsWe included 258 OHCA patients of which 44.6% died during hospitalization. Hospital non-survivors showed significantly higher admission TMAO levels (μmol L−1) compared to hospital survivors (median interquartile range (IQR) 13.2 (6.6–34.9) vs. 6.4 (2.9–15.9), p<0.001). After multivariate adjustment for other prognostic factors, TMAO levels were significantly associated with in-hospital mortality (adjusted odds ratios (OR) 2.1, 95%CI 1.1–4.2, p=0.026). Results for secondary outcomes were similar with significant associations with 90-day mortality and neurological outcome in univariate analyses.ConclusionsIn patients after OHCA, TMAO levels were independently associated with in-hospital mortality and other adverse clinical outcomes and may help to improve prognostication for these patients in the future. Whether TMAO levels can be influenced by nutritional interventions should be addressed in future studies.

OP6  Long term outcomes of participants in the paramedic-2 randomised trial of adrenaline in out of hospital cardiac arrest

2020 ◽  
Vol 37 (10) ◽  
pp. e4.2-e4
Author(s):  
Kirstie L Haywood ◽  
Chen Ji ◽  
Tom Quinn ◽  
Jerry P Nolan ◽  
Charles D Deakin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
General Population ◽  
Drug Administration ◽  
Neurological Outcome ◽  
Randomised Trial ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

BackgroundWe recently reported early outcomes in patients enrolled in a randomised trial of adrenaline in out-of-hospital cardiac arrest: the PARAMEDIC-2 (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest) trial. The purpose of the present paper is to report long-term survival, quality of life, functional and cognitive outcomes in cardiac arrest patients who survived.MethodsPARAMEDIC-2 was a pragmatic, individually randomised, double blind, controlled trial and economic evaluation. Patients were randomised to either adrenaline or placebo. The 12-months survival post randomisation was checked. The 3- and 6-months outcomes included the modified Rankin Scale (0–3 defined as favourable neurological outcome), Two Simple Questions, the Mini Mental State Examination, the Informant Questionnaire on Cognitive Decline Evaluation for Cardiac Arrest, Hospital Anxiety and Depression Scale, the Post Traumatic Stress Disorder Checklist - Civilian Version and general health-related quality of life (HRQoL) assessed with both the Short-Form 12-item Health Survey and the EuroQoL EQ-5D-5L.Results8,014 patients were randomised with confirmed trial drug administration. Adrenaline survivors had marginally better 12-months survival (adjusted odds ratio: 1.385, 95% confidence interval: [1.000, 1.917], p=0.050). There was no significant treatment difference in favourable neurological outcome at both follow-ups. Similarly, no significant difference was found in other outcomes. Moderate to large effect sizes are reported in both arms when survivors were compared to the UK general population regarding general HRQoL and physical health.ConclusionsAdrenaline had a short to long-term effect on survival to 12-months post OHCA, compared to placebo, but more survivors in the adrenaline arm had poor functional, cognitive and HRQoL. A large proportion of the survivors experienced significant cognitive impairment and an important reduction in mental and physical wellbeing over the initial 6-months when compared to the general population.

Sign in / Sign up

Export Citation Format

Share Document