Association between early advanced life support and good neurological outcome in out of hospital cardiac arrest: A propensity score analysis

2019 ◽  
Vol 26 (3) ◽  
pp. 1013-1021
Author(s):  
Laurianne Michelland ◽  
Fréderic Adnet ◽  
Joséphine Escutnaire ◽  
Chloe Baker ◽  
Hervé Hubert ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Neurological Outcome ◽  
Life Support ◽  
Propensity Score Analysis ◽  
Advanced Life Support ◽  
Good Neurological Outcome ◽  
Score Analysis ◽  
Hospital Cardiac Arrest

scholarly journals Prehospital Advanced Cardiac Life Support with a Smartphone-Based Direct Medical Oversight in a Metropolitan City, Korea

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neurological Outcome ◽  
Life Support ◽  
Advanced Life Support ◽  
Neurologic Outcome ◽  
Good Neurological Outcome ◽  
Metropolitan City ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is considered an important health care problem because it causes family breakdown and enormous social loss due to sudden death. Despite the efforts of many medical policymakers, paramedics, and doctors, the survival rate after cardiac arrest is only marginally increasing. Objective: This study aimed to determine whether advanced life support (ALS) under physician’s direct medical oversight during an emergency through video call on smartphones was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on the "Smart Advanced Life Support (SALS)" pilot project. Methods: This study was conducted using a "Before-After" controlled trial. The OHCA patients were divided into two periods in a metropolitan city. The basic life support (BLS group) and ALS using video calls on smartphones (SALS group) were performed in the 'Before' and 'After' phases in 2014 and 2015, respectively. The OHCA patients over 18 years of age were included in this study. On the other hand, the patients with trauma, poisoning, and family’s unwillingness, as well as those who received no resuscitation were excluded from the study. The primary and secondary outcomes were survival to discharge and a good neurological outcome (cerebral performance category [CPC] 1-2), respectively. A propensity score matching was conducted to equalize potential prognostic factors in both groups. The adjusted odds ratio (OR) and 95% confidence interval (95% CI) were calculated for survival to discharge and good neurological outcome. Results: In total, 235 and 198 OHCA patients were enrolled in the BLS and the SALS groups, respectively. The outcomes were better in the SALS group, compared to the BLS group regarding the survival to discharge (9.8% vs. 6.8%, P<0.001) and good neurological outcome (6.6% vs. 4.0%, P<0.001), respectively. Regarding propensity score matching, 304 cases were randomly assigned to the SALS and BLS groups. The survivals to discharge rates after matching were 9.2% and 7.2% in the SALS and the BLS groups, respectively (P=0.06). Furthermore, the good neurological outcome rate was 5.9% in the SALS group versus 3.9% in the BLS group (p=0.008). The adjusted ORs of the SALS group were estimated at 1.33 (95% CI: 1.00-1.77) for survival to discharge and 1.73 (95% CI: 1.19-2.53) for the good neurologic outcome, compared to those in the BLS group. Conclusion: An emergency medical system intervention using the SALS protocol was associated with a significant increase in prehospital ROSC and improved survival and neurologic outcome after OHCA.

P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Akin ◽  
V Garcheva ◽  
J T Sieweke ◽  
J Tongers ◽  
L C Napp ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Therapeutic Hypothermia ◽  
Neurological Outcome ◽  
Life Support ◽  
Neuron Specific Enolase ◽  
Good Neurological Outcome ◽  
Male Predominance ◽  
S 100 ◽  
Hospital Cardiac Arrest

Abstract Purpose To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts. Methods Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA. Results Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l. Conclusion Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.

Abstract 351: Predictors of Neurological Outcome After Out-of-Hospital Cardiac Arrest With Ventricular Fibrillation Witnessed by Emergency Medical Service P.ersonnel., JCS-ReSS Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Katsutaka Hashiba ◽  
Yoshio Tahara ◽  
Kazuo Kimura ◽  
Tsutomu Endo ◽  
Kouichi Tamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Airway Management ◽  
Neurological Outcome ◽  
Medical Service ◽  
Life Support ◽  
Advanced Life Support ◽  
Advanced Airway ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Effective advanced life support is one of the important link in the chain of survival. In Japan, the emergency medical service (EMS) personnel can perform defibrillation, advanced airway management, intravenous access and administration of epinephrine as an advanced life support intervention for the treatment of out-of-hospital cardiac arrest (OHCA). However, whether these interventions performed by EMS improves neurological outcomes remains unclear. Objective: To evaluate predictors of favorable neurological outcome in patients suffering OHCA with ventricular fibrillation (VF) witnessed by an EMS personnel. Methods: The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. To evaluate data after the publication of Guideline2010, data from January 2011 to December 2015 of this database was used for the current analysis. A multivariate logistic-regression analysis was performed to assess factors associated with favorable neurological outcome (defined as Cerebral Performance Category 1 or 2) 1 month after cardiac arrest. Results: Of the 629,471 patients documented for the study period, 2,301 adult patients with an OHCA of cardiac origin and VF for the initial rhythm witnessed by an EMS personnel were included in the present analysis. The overall mortality was 49.6%. Rate of return of spontaneous circulation and favorable neurological outcome were 53.4% and 44.8%, respectively. High age (OR0.387, 95%CI0.316-0.472, p<0.001), delayed defibrillation (OR0.598, 95%CI0.493-0.723, p<0.001), advanced airway management (OR0.305, 95%CI0.223-0.413, p<0.001), administration of epinephrine (OR0.356, 95%CI0.213-0.585, p<0.001) and multiple attempts of defibrillation (OR0.484, 95%CI0.402-0.582, p<0.001) were negatively associated with favorable neurological outcome. Conclusion: In patients with VF witnessed by EMS personnel, resuscitation efforts should simply focus on early defibrillation and CPR without advanced interventions.

Abstract 13226: Epinephrine versus Norepinephrine in Cardiac Arrest Patients With Postresuscitation Shock

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Wulfran Bougouin ◽  
Kaci Slimani ◽  
Marie Renaudier ◽  
Yannick Binois ◽  
Marine Paul ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Analysis ◽  
Controlled Trial ◽  
Cerebral Performance Category ◽  
Multivariate Regression Analysis ◽  
Sensitivity Analyses ◽  
Score Analysis ◽  
Hospital Cardiac Arrest

Backgound: Whether epinephrine or norepinephrine is preferable as the continuous intravenous vasopressor used to treat postresuscitation shock is unclear. Objectives: To compare outcomes of patients with postresuscitation shock after out-of-hospital cardiac arrest according to whether the continuous intravenous vasopressor used was epinephrine or norepinephrine. Methods: We conducted an observational multicenter study of consecutive patients managed in 2011-2018 for postresuscitation shock. The primary outcome was all-cause hospital mortality, and secondary outcomes were cardiovascular hospital mortality and unfavorable neurological outcome (Cerebral Performance Category 3 to 5). A multivariate regression analysis and a propensity score analysis were performed, as well as several sensitivity analyses. Results: Of the 766 patients included in five hospitals, 285 (37%) received epinephrine and 481 (63%) norepinephrine. All-cause hospital mortality was significantly higher in the epinephrine group (OR 2.6; 95%CI, 1.4-4.7; P =0.002). Cardiovascular hospital mortality was also higher with epinephrine (aOR 5.5; 95%CI 3.0-10.3; P <0.001), as was the proportion of patients with CPC of 3 to 5 at hospital discharge. Sensitivity analyses produced consistent results. The analysis involving adjustment on a propensity score to control for confounders showed similar findings (aOR 2.1; 95%CI 1.1-4.0; P =0.02). Conclusions: Among patients with postresuscitation shock after out-of-hospital cardiac arrest, use of epinephrine was associated with higher all-cause and cardiovascular-specific mortality, compared with norepinephrine infusion. A randomized controlled trial comparing the two vasopressors in this population is warranted.

Abstract 106: Differential Effects of Mild Therapeutic Hypothermia Against Normothermia for Post-Cardiac Arrest Syndrome According to the Severity Scale

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mitsuaki Nishikimi ◽  
Takayuki Ogura ◽  
Kazuki Nishida ◽  
Taku Iwami
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Propensity Score Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Good Neurological Outcome ◽  
Moderate Severity ◽  
Differential Effects ◽  
High Severity ◽  
Score Analysis ◽  
Post Cardiac Arrest Syndrome

Introduction: There are few studies on the differential effects of mild therapeutic hypothermia (MTH) according to the risk class in post-cardiac arrest syndrome (PCAS) patients. Objective: The aim of this study was to evaluate the differential effects of MTH against therapeutic normothermia (TN) for PCAS patients according to our risk classification tool (rCAST). Methods: We used data from the out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multi-center, prospective registry of OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department across Japan. We classified eligible PCAS patients treated with MTH or TN on the basis of our rCAST score which was previously developed by us: low severity group (≤5.5), moderate severity group (6-14), and high severity group (≥14.5). The differential effects of MTH vs. TN for their neurological outcome in the 3 severity categories were evaluated by interaction analysis, and the effect of MTH vs. TN in each group was assessed by multivariate logistic regression analysis and propensity score analysis. The good neurological outcome was defined as a Cerebral Performance Categories score ≤2 at 30 days. Results: Among 12,024 OHCA patients in the registry, data of 460 PCAS patients treated by MTH or TN were analyzed (96 patients; the low score, 192; the moderate score, and 172; the high score group). There was a statistically significant interaction effect between MTH/TN and their neurological outcome at 30 days in the 3 categories (p = 0.022). MTH was significantly associated with good neurological outcome at 30 days in PCAS patients of moderate severity group both in the multivariate logistic regression analysis (adjusted odds ratio, 3.09; 95% confidence interval, 1.13-8.49; p = 0.029) and the propensity score analysis (p = 0.030), while it was not in low and high severity group. Conclusions: The effect of MTH in PCAS patients differed according to the severity of PCAS, and MTH was significantly associated with a good neurological outcome as compared to TN in the moderate severity group.

scholarly journals The effects of cardiac arrest recognition by dispatcher on Smart Advanced Life Support

2019 ◽  
Vol 27 (5) ◽  
pp. 286-292
Author(s):  
Choung Ah Lee ◽  
Gi Woon Kim ◽  
Yu Jin Kim ◽  
Hyung Jun Moon ◽  
Yong Jin Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Epinephrine Administration ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Objectives: The purpose of this study was to analyze the effect of cardiac arrest recognition by emergency medical dispatch on the pre-hospital advanced cardiac life support and to investigate the outcome of out-of-hospital cardiac arrest. Method: This study was conducted to evaluate the out-of-hospital cardiac arrest patients over 18 years of age, excluding trauma and poisoning patients, from 1 August 2015 to 31 July 2016. We investigated whether it was a cardiac-arrest recognition at dispatch. We compared the pre-hospital return of spontaneous circulation, the rate of survival admission and discharge, good neurological outcome, and also analyzed the time of securing vein, time of first epinephrine administration, and arrival time of paramedics. Results: A total of 3695 out-of-hospital cardiac arrest patients occurred during the study period, and 1468 patients were included in the study. Resuscitation rate by caller was significantly higher in the recognition group. The arrival interval between the first and second emergency service unit was shorter as 5.1 min on average, and the connection rate of paramedics and physicians before the arrival was 32.3%, which was significantly higher than that of the unrecognized group. The mean time required to first epinephrine administration was 13.1 min, which was significantly faster in the recognition group. However, there was no statistically significant difference between the two groups in patients with good neurological outcome, and rather the rate of return of spontaneous circulation and survival discharge was significantly higher in the non-recognition group. Conclusion: Although the recognition of cardiac arrest at dispatch does not directly affect survival rate and good neurological outcome, the activation of pre-hospital advanced cardiac life support and the shortening the time of epinephrine administration can increase pre-hospital return of spontaneous circulation. Therefore, effort to increase recognition by dispatcher is needed.

Sign in / Sign up

Export Citation Format

Share Document