Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden

2015 ◽  
Vol 16 (8) ◽  
pp. 750-757 ◽  
Author(s):  
Jan Gelberg ◽  
Anneli Strömsöe ◽  
Jacob Hollenberg ◽  
Peter Radell ◽  
Andreas Claesson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Age Groups ◽  
Younger Age ◽  
Neurologic Function ◽  
Hospital Cardiac Arrest

Abstract 299: Out-of-Hospital Cardiac Arrest: A 25 Years Registry

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Margot Cassuto ◽  
Armelle Severin ◽  
Cecile Ursat ◽  
Anna Ozguler ◽  
Michel Baer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Public Awareness ◽  
Age Groups ◽  
Heart Association ◽  
Spontaneous Circulation ◽  
Age Group ◽  
Younger Age ◽  
Cardio Vascular ◽  
Hospital Cardiac Arrest

Introduction: For many years, organizations like American Heart Association (AHA) published guidelines for the management of Out-of-Hospital Cardiac Arrest (OHCA). Our Emergency Medical Service (EMS), in a catchment of 500,000 inhabitants, has registered all OHCA since 1993. The aim of this study was to describe evolution of the on scene return of spontaneous circulation (ROSC) after OHCA from cardio-vascular cause (CV) over the past years. Methods: Data were collected from an EMS registry since 1993. The study included adult patients with OHCA from CV. Collected data were evolution (death or ROSC), gender, age group (older than 15) and periods (1993-1999, 2000-2004, 2005-2009, 2010-2014, 2015-2017). The primary outcome was rate of on scene ROSC. Comparisons were performed with Chi-2 test and logistic regression. Results: The registry included 8761 adults with OHCA, 7165 (82.2%) of which had a CV. Mean age was 71.6 years old (SD 16.9), 58.7% were male. ROSC rate was 15.2%. ROSC increased from 10.3% before 2000 to 19.8% after 2015, addressing significantly all age groups except the oldest (figure 1). ROSC rate was 17% for men and 12% for women. Logistic regression results (adjusted and not) showed a greater chance of ROSC for younger patients (OR ranging from 2.1 for age group 60-74 until 4.3 for 16-29 age group, compared with ≥ 75 age group), if OHCA occurred recently (OR ranging from 1.5 for 2010-214 period to 2.6 for < 2000 period compared with ≥ 2015) and for males (OR=1.3). Conclusion: This study shows increase of ROSC after OHCA, mainly for younger age groups, during this last 25 years. This may be due to evolution of public awareness and medical practice according to guidelines. In addition, women did not benefit from this evolution as much as men did. In the future, as the "Go Red for Women" campaign, efforts to improve survival of OHCA should focus on women.

Abstract P75: Dissemination of CPR Skills to the Public - Can Schoolchildren Ensure Success?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tonje Lorem ◽  
Aud Palm ◽  
Lars Wik
Keyword(s):  
Cardiac Arrest ◽  
Large Fraction ◽  
Age Groups ◽  
Health Benefit ◽  
School Students ◽  
The Public ◽  
Group 3 ◽  
Second Tier ◽  
Group 2 ◽  
Hospital Cardiac Arrest

Training a large fraction of the general population in CPR could have major public health benefit if those most likely to witness cardiac arrest are trained. Mass distribution of self-training manikins as a two-tiered strategy with school children as first tier has been described as successful, but without information on second tier age or information strategy to second tier. We studied three different attempts at reaching older second tier persons. In groups 1 and 2 first tier consisted of 7 th graders and in group 3 high school and medical school students. Information about the desirable second tier age group was given in writing prior to the distribution. In groups 1 and 3 information was only directed towards first tier. In group 2 both first tier, their parents and teachers were informed. The first tier participants reported the number of second tier trained for age-groups 12–25 years, 25–50 years, and >50 years. Approximately 64000 (group 1), 63000 (group 2) and 81 (group 3) self-education kits were provided with 2.7, 1.9, and 3.7 lay-rescuers trained per kit respectively (p<0.05) (Table 1 ). Informing also the parents of the first tier prior to the distribution did not positively impact the number of second tier trained lay-rescuers, but higher age of first tier did. We speculate that 7 th graders are too young to successfully disseminate CPR to those most likely to witness out of hospital cardiac arrest. Table 1. Percentage reported trained in first and second tier divided into age-groups.

scholarly journals Low PCSK-9 levels Are Associated with Favorable Neurologic Function after Resuscitation from out of Hospital Cardiac Arrest

2020 ◽  
Vol 9 (8) ◽  
pp. 2606
Author(s):  
Anne Merrelaar ◽  
Nina Buchtele ◽  
Christoph Schriefl ◽  
Christian Clodi ◽  
Michael Poppe ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Primary Outcome ◽  
Characteristic Curve ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hepatic Uptake ◽  
Logistic Regression Models ◽  
Neurologic Function ◽  
Hospital Cardiac Arrest

Endotoxemia after cardiopulmonary resuscitation (CPR) is associated with unfavorable outcome. Proprotein convertase subtilisin/kexin type-9 (PCSK–9) regulates low-density lipoprotein receptors, which mediate the hepatic uptake of endotoxins. We hypothesized that PCSK–9 concentrations are associated with neurological outcome in patients after CPR. Successfully resuscitated out-of-hospital cardiac arrest patients were included prospectively (n = 79). PCSK–9 levels were measured on admission, 12 h and 24 h thereafter, and after rewarming. The primary outcome was favorable neurologic function at day 30, defined by cerebral performance categories (CPC 1–2 = favorable vs. CPC 3–5 = unfavorable). Receiver operating characteristic curve analysis was used to identify the PCSK–9 level cut-off for optimal discrimination between favorable and unfavorable 30-day neurologic function. Logistic regression models were calculated to estimate the effect of PCSK–9 levels on the primary outcome, given as odds ratio (OR) and 95% confidence interval (95%CI). PCSK–9 levels on admission were significantly lower in patients with favorable 30-day neurologic function (median 158 ng/mL, (quartiles: 124–225) vs. 207 ng/mL (174–259); p = 0.019). The optimally discriminating PCSK–9 level cut-off was 165 ng/mL. In patients with PCSK–9 levels ≥ 165 ng/mL, the odds of unfavorable neurological outcome were 4.7-fold higher compared to those with PCSK–9 levels < 165 ng/mL. In conclusion, low PCSK–9 levels were associated with favorable neurologic function.

Abstract 9764: Prevalence of Inappropriate Defibrillation Attempts During Pediatric In-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
James M Gray ◽  
Tia T Raymond ◽  
Dianne L Atkins ◽  
Ken Tegtmeyer ◽  
Dana E Niles ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Age Groups ◽  
Inappropriate Shock ◽  
Shock Delivery ◽  
Inappropriate Shocks ◽  
Hospital Cardiac Arrest ◽  
Significant Opportunity ◽  
Age Category

Introduction: Shockable rhythms (ventricular fibrillation [VF] and ventricular tachycardia [VT]) occur in <25% of pediatric in-hospital cardiac arrest (IHCA) events, yet the prevalence of inappropriate defibrillation attempts for non-VF/VT rhythms is unknown. We aim to describe the prevalence of inappropriate shocks across a large, multi-national pediatric cardiac arrest network. Methods: We included children <18y reported to the pedi atric RES uscitation- Q uality (pediRES-Q) network from 2015-2019 with complete defibrillator files who received defibrillation attempts during IHCA (ZOLL R-Series, MA). Two pediatric cardiologists independently classified rhythms immediately prior to shock as: 1) appropriate (VF or wide complex ≥ 150/min), 2) indeterminate (narrow complex ≥150/min or wide complex 100-149/min), or 3) inappropriate (asystole, sinus, narrow complex <150/min, or wide complex <100/min). Rhythms that were undecipherable due to artifact were excluded from analysis (n=22). Disagreements were resolved by arbitration and consensus. Results: Of 896 IHCA events, 124 (14%) had defibrillation attempts. A total of 303 shocks were delivered: 87 (29%) in age <1y, 84 (28%) in 1-8y, and 132 (44%) in 9-17y. Of shocks delivered, 206 (68%) were appropriate, 12 (4%) indeterminate, and 85 (28%) inappropriate. There was no difference in inappropriate shock delivery by age category: <1y (24/87, 28%), 1-8y (26/84, 31%), 9-17y (35/132, 27%) ( p =0.4). Conclusions: Across a multi-national pediatric cardiac arrest network, a large proportion (28%) of defibrillation attempts were inappropriate, suggesting significant opportunity for improvement in rhythm identification in pediatric cardiac arrest. There was no difference in inappropriate shock delivery across age groups. Figure 1. Representation of rhythm classification and appropriateness of defibrillation attempts with exemplar rhythms.

Abstract 146: Neurological Prognostication by Gender in Patients with Out-of-Hospital Cardiac Arrest Receiving Hypothermia Treatment

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Min Jung Kim ◽  
Sang Do Shin ◽  
William McClellan ◽  
Bryan McNally
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Rhythm ◽  
Age Groups ◽  
Patient Characteristics ◽  
Neurologic Outcome ◽  
Neurologic Recovery ◽  
Hypothermia Treatment ◽  
Shockable Rhythm ◽  
Gender And Age ◽  
Hospital Cardiac Arrest

Objectives: This study aimed to to examine whether neurologic recovery of out-of-hospital cardiac arrest patients receiving hypothermia treatment is enhanced for women of childbearing age. Methods: A cross-sectional analysis was conducted using a nationwide surveillance database in Korea of out-of-hospital cardiac arrest (OHCA) that occurred between 2008 and 2012. The exposure and outcomes studied were hypothermia treatment and neurologic outcome at discharge. Patient characteristics between hypothermia-treated and non-treated groups were compared. Multivariate logistic regression was used to account for the patient characteristics. The association was examined for each stratum of gender, age (<45, 45-65, and >65 years old), and initial cardiac rhythm. Cardiac rhythms were considered in two different categorizations: 1) shockable/non-shockable rhythm, and 2) VF.VT/PEA/asystole. Results: Crude analysis showed that women of childbearing ages treated with hypothermia had enhanced neurologic recovery than older aged women and all men. After adjusted, men had stronger association between hypothermia and good neurologic recovery than women. The highest association was found in men who are under 45 years of age and have shockable cardiac rhythm (OR=2.00 (1.26, 3.19)). The association between hypothermia and neurologic recovery was not statistically significant in all women. The magnitude of association decreased with age. Shockable rhythm was associated with better neurologic recovery than non-shockable rhythms in all gender and age groups. Using VF.VT/PEA/asystole categorization of cardiac rhythms, men consistently showed higher ORs than women. In all gender and age groups, having PEA rhythm was associated with better neurologic outcome than shockable rhythms (VF/VT) or asystole. Conclusion: The unadjusted association between hypothermia and neurologic recovery was the strongest in women of childbearing ages. After adjustment, men had a better neurologic outcome than women across all ages. Shockable rhythms were associated with enhanced neurologic recovery. Our results suggest that among OHCA patients, the effect of hypothermia treatment on neurologic recovery is greater for men, young ages, and having shockable cardiac rhythm.

Abstract 111: Age-Dependent Trends in Survival After Adult In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sebastian Wiberg ◽  
Mathias J Holmberg ◽  
Michael Donnino ◽  
Jesper Kjaergaard ◽  
Christian Hassager ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Age Groups ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Absolute Increase ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims or extends to older patients as well. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. Methods: This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between January 2000 and December 2016. The primary outcome was survival to hospital discharge, while secondary outcomes included rates of return of spontaneous circulation (ROSC) and neurological outcome at discharge. Patients were stratified into five age groups: < 50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. Analyses of interaction were included to assess differences in survival trends between age groups. Results: A total of 234,767 IHCA patients were included for the analyses. The absolute increase in survival per calendar year was 0.8% (95%CI 0.7 - 1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95%CI 0.4 - 0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients older than 80 years. Further, a significant increase in both rates of ROSC and survival with a good neurological outcome was seen for all age groups. In both unadjusted and adjusted analyses of survival, we observed a significant interaction between calendar year and age group ( p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. Conclusions: For patients with IHCA, survival to discharge, ROSC, and survival to discharge with a good neurological outcome have improved significantly from 2000 to 2016 for all age groups.

Abstract 14172: Impact of Sex on Survival With Preserved Neurologic Function Following Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Fatima Lakhani ◽  
Brendan Caprio ◽  
Elena Deych ◽  
David L Brown
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Menopausal Status ◽  
Favorable Outcome ◽  
Categorical Variables ◽  
Female Sex ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Neurologic Function ◽  
Hospital Cardiac Arrest

Introduction: Females experience worse survival than males following out-of-hospital cardiac arrest (OHCA). Proposed explanations include previous observations that females less often have an initial shockable rhythm or a witnessed arrest and less often receive bystander CPR. Methods: We utilized a prospective, population-based registry of patients experiencing OHCA responded to by EMS from 2011-2015. We included patients 18 years or older who were admitted to the hospital. Univariate comparisons were performed with chi-squared test for categorical variables and t-test for age. Additional analysis compared outcomes stratified by age > 50 years as a surrogate for menopausal status. A multivariate logistic regression model was constructed to evaluate the independent association of sex with outcomes. The primary outcome was survival to hospital discharge with Modified Rankin Score (MRS) ≤3. Results: Of 13,651 patients, 4894 were female and 8757 were male. The average age was 65 years for females and 64.2 years for males (P=0.005). Females were less likely than males to arrest in a public location (13% vs 27%; P <0.001), have bystander witnessed arrest (48% vs 57%; P <0.001), receive bystander CPR (44% vs 49%; P <0.001), have an initial shockable rhythm (29% vs 48%; P <0.001), have achieved ROSC upon ED arrival (76% vs 78%; P=0.014), have an ED arrival time less than 30 minutes from dispatch call (10% vs 12% P=0.008). Among males, 27% had a favorable outcome compared to 16% of females (P <0.0001). Among individuals of age ≤ 50 years, 31% of males and 26% of females had a favorable outcome (P= 0.004). Among those of age > 50 years, 26% of males and 14% of females had a favorable outcome (P <0.0001). After adjustment for differences in age and presentation, female sex was found to be independently associated with lower rates of survival with intact neurologic function (OR 0.79, 95% CI 0.71-0.89, P =0.0001). Conclusions: Compared to males, females have less favorable OHCA presentations and worse survival to hospital discharge with preserved neurologic function. However, even after adjustment for the differences in presentation, female sex remains a significant predictor of worse survival with preserved neurologic function.

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