Cerebral Performance Category at Hospital Discharge Predicts Long-Term Survival of Cardiac Arrest Survivors Receiving Targeted Temperature Management*

Introduction: Cardiac arrest (CA) is a leading cause of death in the United State, affecting 600,000 people annually with overall survival rate of less than 10%. CPR and cooling are the few effective treatments that improve CA survival. No drugs are currently available to improve survival. Active cooling is more effective than targeted temperature management in improving survival, but can be difficult to implement clinically. We have developed a novel peptide (TAT-PHLPP) that inhibits PH domain and Leucine rich repeat Protein Phosphatases (PHLPP). When this peptide was administered intravenously (i.v.) during CPR, it expresses in both heart and brain within 5 min of intravenous injection and significantly improved 4 h survival in a 12 min mouse asystole arrest model. Hypothesis: We hypothesize that TAT-PHLPP improves neurologically intact long-term survival following SCA with improved early metabolic recovery. Methods: C57BL6 mice (n=20) were randomized to receive peptide treatment and appropriate blinding was ensured. A 12 min asystolic arrest was induced with KCl. CPR was started along with TAT-PHLPP (7.5 mg/kg) via i.v. Three day Survival was evaluated. Cerebral blood flow (CBF) and metabolic chemical exchange saturation transfer (CEST) contrast were measured with endogenous and dynamic arterial spin labeling (ASL) and CEST MRI respectively. Glucose utilization was assessed by pyruvate dehydrogenase (PDH) phosphorylation and ATP generation. Further, blood taurine and glutamate were measured. Results: Baseline characteristics including weight, temperature, heart rate, MAP were indistinguishable between the control (normal saline, NS) and peptide group. Compared to NS, TAT-PHLPP significantly improved 3-day survival with better neurological function. It progressively increased CBF and metabolic CEST contrast. It decreased p-PDH (increased activity) at 15 min post-ROSC and enhanced ATP generation in both heart and brain. It also reduced plasma taurine and glutamate concentrations as early as 5 min post-ROSC. Further, high levels of taurine and glutamate were detected in non-survivors. Conclusions: This novel therapy may have a high translational potential to reproduce critical outcomes of CPR cooling without physical cooling.

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Abstract 13013: Survival After In-Hospital Cardiopulmonary Resuscitation for Cardiac Arrest in Patients With COVID-19: An Updated Meta-Analysis

Circulation ◽

10.1161/circ.144.suppl_2.13013 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Archana Pattupara ◽

Devika Aggarwal ◽

Kirtipal S Bhatia ◽

Olga Gomez-Rojas ◽

vardhmaan jain ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Meta Analysis ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Neurological Recovery ◽

Term Survival ◽

Performance Category ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Introduction: Several small studies have reported variable outcomes following in-hospital cardiac arrest (IHCA) in patients with COVID-19. A clear estimate is important in prognostication and guiding resuscitation efforts and policies for these patients. Methods: A search of PubMed, Embase, and Scopus databases was conducted to identify studies reporting outcomes after IHCA in adult patients with confirmed COVID-19. The cumulative characteristics of the patients were described. The primary outcome studied was survival at 30 days or at hospital discharge (short term survival). Additional outcomes of interest were proportional prevalence of the initial rhythm at arrest, return of spontaneous circulation (ROSC), and neurological recovery (defined as Cerebral Performance Category Score of 1-2 ). Metanalysis of proportions was performed utilizing the Metaprop command. A random effects model was chosen to account for interstudy variance. Results: A total of 13 eligible studies were identified and included in the analyses. Out of all the hospitalized patients with COVID-19, 1,618 underwent advanced cardiac resuscitation after an IHCA. Patients who had a cardiac arrest had a median age between 50-69 years. IHCA occurred predominantly in men, and in the ICU setting. Shockable rhythms were identified in 8% (95% CI 5-10%, I2; 56%) and non-shockable rhythms in 89% (95% CI 85-94% I2; 84%) of patients (Fig. 1a). ROSC was achieved in 40% (95% CI 31-48% I2; 90%) (Fig. 1b). Only 7 % ( 95% CI 3-12% I2; 86%) of patients survived at 30 days/hospital discharge (Fig. 1c). Neurological recovery was seen in 5% (95% CI 3-9% I2; 67%) of patients who suffered a IHCA (Fig. 1d). Conclusions: Our meta-analysis demonstrates the majority of the cardiac arrests in patients with COVID-19 have non-shockable rhythms. Survival rate in these patients is low, and neurological recovery is unfavorable. This study provides further insight in guiding resuscitation efforts in these patients.

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Mortality and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients With and Without Targeted Temperature Management in a Multiethnic Asian Population

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2019184 ◽

2020 ◽

Vol 49 (3) ◽

pp. 127-136

Author(s):

Wan Jing Tay ◽

Huihua Li ◽

Andrew FW Ho ◽

Ching Hui Sia ◽

Georgina GJ Kwek ◽

...

Keyword(s):

Cardiac Arrest ◽

Statistical Significance ◽

Cerebral Performance Category ◽

Asian Population ◽

Targeted Temperature Management ◽

Temperature Management ◽

Academic Medical Centre ◽

Performance Category ◽

Neurological Outcomes ◽

Hospital Cardiac Arrest

Introduction: The use of targeted temperature management (TTM) is increasing although adoption is still variable. We describe our 6-year experience and compare the mortality and neurological outcomes of out-of-hospital cardiac arrest (OHCA) patients with and without the use of TTM in a multiethnic Asian population. Materials and Methods: We performed a retrospective observational study at a tertiary academic medical centre. OHCA survivors admitted to our hospital between April 2010‒December 2016 were included. Outcomes of interest were 30-day mortality postresuscitation, Cerebral Performance Category (CPC) and Overall Performance Category (OPC) scores. Results: A total of 121 of 261 patients (46.3%) underwent TTM. TTM patients were younger (TTM 60.0 years old vs no TTM 63.7 years old, P = 0.047). There was no difference in the initial arrest rhythm of shockable origin between the 2 groups (P = 0.289). There was suggestion of lower 30-day mortality (TTM 24.3% vs no TTM 31.4%, P = 0.214), higher and good CPC/OPC scores (TTM 19.0% vs no TTM 15.7%, P = 0.514) with TTM although this did not reach statistical significance. On multivariable logistic regression analysis, TTM was not associated with 30-day mortality (P = 0.07). However, older age, initial non-shockable rhythm and increased duration from arrest to return of spontaneous circulation were associated with increased mortality. Malay ethnicity was associated with a poorer CPC/OPC score. Conclusion: Adoption and outcomes of TTM postresuscitation is variable and there is still a need to optimise management of the identified predictors of survival and good neurological outcomes while TTM is being used. Key words: Heart attack, Neurological function, Neuroprotection, Therapeutic hypothermia

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Faculty Opinions recommendation of Survival After Out-of-Hospital Cardiac Arrest in Relation to Age and Early Identification of Patients With Minimal Chance of Long-Term Survival.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725381975.793527134 ◽

2017 ◽

Author(s):

Cameron Dezfulian

Keyword(s):

Cardiac Arrest ◽

Early Identification ◽

Term Survival ◽

Long Term Survival ◽

Hospital Cardiac Arrest

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Impact of the cardiopulmonary resuscitation-related injuries on the prognosis after cardiac arrest

European Heart Journal ◽

10.1093/ehjci/ehaa946.1819 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Merino Argos ◽

I Marco Clement ◽

S.O Rosillo Rodriguez ◽

L Martin Polo ◽

E Arbas Redondo ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

University Hospital ◽

Temperature Management ◽

Performance Category ◽

Neurological Outcomes ◽

Cardiac Care Unit ◽

Sternal Fractures

Abstract Background Cardiopulmonary resuscitation (CPR) manoeuvres involve vigorous compressions with the proper depth and rate in order to keep sufficient perfusion to organs, especially the brain. Accordingly, high incidences of CPR-related injuries (CPR-RI) have been observed in survivors after cardiac arrest (CA). Purpose To analyse whether CPR-related injuries have an impact on the survival and neurological outcomes of comatose survivors after CA. Methods Observational prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary university hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (TTM 32–34°) from August 2006 to December 2019. CPR-RI were diagnosed by reviewing medical records and analysing image studies during hospitalization. Results A total of 498 pts were included; mean age was 62.7±14.5 years and 393 (78.9%) were men. We found a total of 145 CPR-RI in 109 (21.9%) pts: 79 rib fractures, 20 sternal fractures, 5 hepatic, 5 gastrointestinal, 3 spleen, 1 kidney, 26 lung and 6 heart injuries. Demographic characteristics and cardiovascular risk factors did not differ between the non-CPR-RI group and CPR-RI group. Also, we did not find differences in CA features (Table 1). Survival at discharge was higher in the CPR-RI group [74 (67.8%) vs 188 (48.3%); p<0.001]. Moreover, Cerebral Performance Category (CPC) 1–2 within a 3-month follow-up was significantly higher in the CPR-RI group [(71 (65.1%) vs 168 (43.2%); p<0.001; Figure 1]. Finally, pts who recieved blood transfusions were proportionally higher in the CPR-RI group [34 (32.1%) vs 65 (16.7%)]; p=0.004). Conclusions In our cohort, the presence of CPR-RI was associated with higher survival at discharge and better neurological outcomes during follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

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