scholarly journals Neuropsychological Outcome following Resuscitation after Out-of-Hospital Cardiac Arrest: A One-Year Follow-Up

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Jeannette Overbeck ◽  
Frank-Michael Schweers
Keyword(s):  
Cardiac Arrest ◽  
Effective Treatment ◽  
Cognitive Impairments ◽  
Neuropsychological Testing ◽  
Neuropsychological Outcome ◽  
One Year ◽  
Hospital Cardiac Arrest

A 61-year-old woman survived resuscitation after out-of-hospital cardiac arrest. The heterogeneity of the resulting cognitive impairments and the recovery over a one-year period are presented, highlighting the need for standardized neuropsychological testing even after short cardiac arrests and for effective treatment both out of hospital and in hospital.

5226The majority of 30-day survivors of in-hospital cardiac arrest are alive one-year post-arrest without anoxic brain damage, admission to nursing home or need of in-home care

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Yonis ◽  
K Bundgaard ◽  
R Noermark Mortensen ◽  
M Wissenberg ◽  
G Gislason ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Nursing Home ◽  
Home Care ◽  
Brain Damage ◽  
Nursing Home Admission ◽  
Risk Of Death ◽  
Study Population ◽  
One Year ◽  
Hospital Cardiac Arrest

Abstract Background Survivors of in-hospital cardiac arrest are at risk of anoxic brain damage that can lead to admission to nursing home or need of in-home care. However, studies on long-term outcomes after in-hospital cardiac arrest are scarce with previous research focusing on short term measures such as survival-to-discharge. Purpose This study aimed to investigate the composite endpoint of nursing home admission or anoxic brain damage among 30-day survivors of in-hospital cardiac arrest within the first-year post-arrest. As a sub analysis, we also investigated the additional need of in-home care. Methods All in-hospital cardiac arrests in 13 Danish hospitals during 2013–2015 were identified from the DANARREST register. Inclusion criteria were indication for a resuscitation attempt and survival to day 30. Patients who, prior to arrest, already lived in a nursing home, and/or had anoxic brain damage were excluded. In the sub analysis patients who received in-home care prior to arrest were also excluded. The DANARREST data was linked to nationwide registries including the National Patient Register and administrative nursing home and home care registries using the Danish Civil Registration Number, a unique personal identification number that is given to every citizen in Denmark. Results The primary study population comprised of 454 (26.3%) 30 day-survivors out of 1723 eligible patients. Median age was 67 (Q1-Q3 57–75); 301 (66.9%) were men. In this group, the 1-year risk of anoxic brain damage or nursing home admission was 4.6% (95% CI 2.7%- 6.6%) with a competing risk of death of 15.6% (95% CI 12.3%-19.0%), leaving 79.8% alive without anoxic brain damage or nursing home admission at one-year follow-up (see Figure 1A). The sub study population comprised of 343 30-day survivors with a 1-year risk of anoxic brain damage, nursing home admission or need of in-home care of 23.6% (95% CI 19.1%-28.1%). The competing risk of death was 7.6% (95% CI 4.8%-10.4%), leaving 68.8% alive without anoxic brain damage, nursing home admission or need of in-home care at one-year follow-up (see Figure 1B). Figure 1 Conclusion The majority of 30-day survivors of in-hospital cardiac arrest were alive at one-year follow-up without being diagnosed with anoxic brain damage, admitted to nursing home or without need of in-home care.

scholarly journals Contacts to the healthcare system prior to out-of-hospital cardiac arrests

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Zylyftari ◽  
S.G Moller ◽  
M Wissenberg ◽  
F Folke ◽  
C.A Barcella ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
General Population ◽  
Healthcare System ◽  
Early Identification ◽  
Sudden Cardiac Arrest ◽  
Funding Source ◽  
Horizon 2020 ◽  
One Year ◽  
Public Grant ◽  
Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

scholarly journals Health-related quality of life after out-of-hospital cardiac arrest – a five-year follow-up studyJūratė Šaltytė Benth

Resuscitation ◽  
2021 ◽  
Author(s):  
Henning Wimmer ◽  
Christofer Lundqvist ◽  
Jūratė Šaltytė Benth ◽  
Knut Stavem ◽  
Geir Ø. Andersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Hospital Cardiac Arrest

scholarly journals Longitudinal two years evaluation of neuropsychological outcome in children after out of hospital cardiac arrest

Resuscitation ◽  
2021 ◽  
Author(s):  
Maayke Hunfeld ◽  
Karolijn Dulfer ◽  
Andre Rietman ◽  
Robert Pangalila ◽  
Annabel van Gils-Frijters ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neuropsychological Outcome ◽  
Hospital Cardiac Arrest

scholarly journals Recovery from Transient Global Amnesia Following Restoration of Hippocampal and Fronto–Cingulate Perfusion

2010 ◽  
Vol 22 (3-4) ◽  
pp. 131-139 ◽  
Author(s):  
Paolo Caffarra ◽  
Letizia Concari ◽  
Simona Gardini ◽  
Sabrina Spaggiari ◽  
Francesca Dieci ◽  
...  
Keyword(s):  
Acute Phase ◽  
Neuropsychological Testing ◽  
Transient Global Amnesia ◽  
Normal Limits ◽  
Global Amnesia ◽  
One Year ◽  
The Right ◽  
Rcbf Spect ◽  
Subject Comparison

A patient who suffered a transient global amnesia (TGA) attack underwent regional cerebral blood flow (rCBF) SPECT imaging and neuropsychological testing in the acute phase, after one month and after one year. Neuropsychological testing in the acute phase showed a pattern of anterograde and retrograde amnesia, whereas memory was within age normal limits at follow up. SPECT data were analysed with a within subject comparison and also compared with those of a group of healthy controls. Within subject comparison between the one month follow up and the acute phase detected increases in rCBF in the hippocampus bilaterally; further rCBF increases in the right hippocampus were detected after one year. Compared to controls, significant hypoperfusion was found in the right precentral, cingulate and medial frontal gyri in the acute phase; after one month significant hypoperfusion was detected in the right precentral and cingulate gyri and the left postcentral gyrus; after one year no significant hypoperfusion appeared. The restoration of memory was paralleled by rCBF increases in the hippocampus and fronto-limbic-parietal cortex; after one year neither significant rCBF differences nor cognitive deficits were detectable. In conclusion, these data indicate that TGA had no long lasting cognitive and neural alterations in this patient.

Abstract 26: Prevalence and Pattern of Myocardial Injury in Patients With Cardiac vs Non-Cardiac Cause of Out-Of-Hospital Cardiac Arrest: A One-Year Multicenter Clinical Experience With the High-Sensitivity Troponin T Assay

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
David E Hamilton ◽  
Bradley J Petek ◽  
Lindsay G Panah ◽  
Sean R Mendez ◽  
Philip E Dormish ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Injury ◽  
Troponin T ◽  
Clinical Care ◽  
High Sensitivity ◽  
Severity Of Injury ◽  
High Sensitivity Troponin T ◽  
One Year ◽  
Hospital Cardiac Arrest

Introduction: Myocardial injury is common after out-of-hospital-cardiac arrest (OHCA). However, little is known about the role of early serial hs-TnT in patients with OHCA for identifying myocardial injury, and whether the prevalence and severity of injury differs according to cardiac (CV) vs noncardiac (non-CV) cause of OHCA. Hypothesis: Early hs-TnT will demonstrate high rates of myocardial injury after OHCA regardless of etiology. However, in the first 6 hours after OHCA the extent of hs-TnT elevation and rate of rise will be higher in patients with CV vs non-CV etiology. Methods: Multicenter retrospective study including OHCA patients presenting from 4/1/2018 to 4/1/2019. Hs-TnT was drawn as part of routine clinical care. Results: Baseline hs-TnT was measured in 120 patients after OHCA due to CV (n=51) and non-CV (n=69) etiologies, with subsequent serial hs-TnT values at 1hr, 3hrs, and 6hrs. Hs-TnT was greater than the 99 th percentile in 97% (115/120) of patients and myocardial injury (hs-TnT> 52ng/L) was detected in 88% (105/120) of patients (no difference between CV vs non-CV etiology). Median hs-TnT values were compared between CV and non-CV etiologies of OHCA identifying no difference in hs-TnT at baseline (Figure: 54 [IQR 18-134] vs. 41 [IQR 19-100]; p=0.357) but significantly higher hs-TnT in patients with CV etiology at 1hr (159 [IQR 80-392] vs 93 [IQR 42-247]; p=0.049), 3hrs (400 [IQR 168-1005] vs 151 [IQR 75-401] p=0.009), and 6hrs (746 [IQR 248-1965] vs 251 [IQR 75-580]; p=0.001). Additionally, hs-TnT rise from baseline was present in both CV and non-CV etiologies but was significantly higher in patients with CV etiology (p = 0.005). Conclusions: As identified by hs-TnT, myocardial injury was prevalent in patients with both CV and non-CV cause of OHCA. Baseline hs-TnT was no different in patients with CV vs non-CV cause, however, over the first 6 hours both absolute value and rate of hs-TnT rise were significantly higher for patients with CV vs non-CV etiology of OHCA.

Abstract 141: Resuscitation Time Bias in an Observational Study of Mechanical Chest Compression CPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Michael K Levy ◽  
Karl B Kern ◽  
Dana Yost ◽  
Bjarne Madsen Hardig ◽  
Fred W Chapman
Keyword(s):  
Cardiac Arrest ◽  
Observational Studies ◽  
Spontaneous Circulation ◽  
Prolonged Treatment ◽  
Device Application ◽  
Group Response ◽  
Device Use ◽  
One Year ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Recent observational studies have found associations between poorer outcomes and treatment that included mechanical CPR devices, contradicting findings from randomized trials. Resuscitation time bias is a systematic error occurring in observational studies of interventions applied to pulseless patients later in resuscitation attempts. Previous observational studies lack data on duration of resuscitation, a factor strongly related to outcome. We retrospectively analyzed cardiac arrest data to learn how resuscitation time and device use relate to clinical outcomes, and determine whether resuscitation time bias was present. Methods and Results: We analyzed data from all 49 patients with ventricular fibrillation, out-of-hospital cardiac arrest treated by our emergency medical service in one year. We compared 19 patients who received only standard manual CPR (the sCPR group) to 30 patients who received manual followed by mechanical CPR (the mCPR group). Response to CPR differed between groups even before device application. All sCPR patients achieved return of spontaneous circulation (ROSC), and did so after a median (IQR) of 3.3 (2.2-5.1) minutes of manual CPR. Patients in the mCPR group failed to get ROSC through 6.9 (5.3-11.0) min of manual CPR; mCPR patients that did get ROSC did so after 11.2 (5.7-23.8) additional minutes of CPR, delivered by a mechanical device. mCPR patients also received significantly more defibrillations and ALS drugs. ROSC and survival to hospital discharge were higher in the sCPR than the mCPR group (100% vs. 70%, P = 0.008; 74% vs. 43%, P = 0.045). Conclusion: Only patients remaining pulseless after early resuscitation efforts received mechanical CPR. Consequently, mechanical CPR devices assisted by facilitating prolonged treatment of patients who already had lower chances of survival before device application. Resuscitation time bias was present, and must be considered when interpreting registry reports comparing sCPR and mCPR.

P6471Pronostic impact of significant valvular disease in long-term survivors of out-of-hospital-cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rodriguez ◽  
J Caro-Codon ◽  
J R Rey-Blas ◽  
S O Rosillo ◽  
O Gonzalez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Percutaneous Treatment ◽  
Valvular Disease ◽  
Temperature Management ◽  
P Value ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Background There is scarce evidence about the prevalence and clinical relevance of moderate to severe valvular heart disease (VHD) in survivors of out of hospital cardiac arrest (OHCA). Purpose To determine whether VHD influence prognosis of OHCA survivors. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Univariate and multivariate Cox-proportional hazard models were employed. Results A total of 201 patients were included in the analysis. Mean age was 57.6±14.2 years and 168 (83.6%) were male. Eighteen patients (9.0%) had moderate or severe VHD during index admission (Table 1). Patients with VHD were less frequently of male sex, [11 (61.1%) vs 157 (85.8%), p=0.014], experienced less acute coronary syndrome-related arrhytmias [2 (11.1%) vs 85 (46.5%), p=0.005], and had a lower pH at hospital admission (6.9±1.6 vs 7.2±0.15, p=0.008). During a median follow-up of 40.3 (18.9–69.1) months, patients with VHD showed higher mortality [7 (38.9%) vs 28 (15.3%), p=0.004] and more heart failure-related admissions [7 (38.9%) vs 15 (8.2%), p<0.001]. Only five patients received surgical or percutaneous treatment for VHD during follow-up, with no deaths in this subgroup. Moderate or severe VHD proved to be an independent predictor of global cardiovascular events and specifically heart failure episodes (Figure 1). Table1 Variable With valvular disease Without valvular disease p value Age, mean±DS, years 63.5±13.2 57.0±14.1 0.066 Hypertension, n (%) 12 (66.7) 95 (51.9) 0.231 Diabetes, n (%) 5 (27.8) 24 (13.1) 0.149 Dyslipidaemia, n (%) 7 (38.9) 79 (43.2) 0.726 Smokin habit, n (%) 4 (22.2) 90 (49.2) 0.045 Witnessed cardiac arrest, n (%) 18 (100) 175 (95.6) 1.000 Time from CA to ROSC, mean±DS, minute 19.1±7.5 21.2±13.1 0.506 Shockable rhythm, n (%) 13 (72.2) 163 (89.1) 0.055 LVEF at hospital discharge (%) 42.8±12.1 46.9±14.6 0.254 Figure 1 Conclusion The presence of significant VHD in survivors after OHCA is a predictor of poor outcomes. Specific management of VHD may be specially relevant in this high-risk patients and guideline-oriented therapy, including surgery and percutaneous intervention should be encouraged when indicated.

scholarly journals Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Abdul H. Qazi ◽  
Paul S. Chan ◽  
Yunshu Zhou ◽  
Mary Vaughan-Sarrazin ◽  
Saket Girotra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Baseline Period ◽  
Hospital Performance ◽  
Hierarchical Regression ◽  
Similar Proportion ◽  
Large Improvement ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: A hospital’s risk-standardized survival rate (RSSR) for in-hospital cardiac arrest has emerged as an important metric to benchmark and incentivize hospital resuscitation quality. We examined whether hospital performance on the RSSR metric was stable or dynamic year-over-year and whether low-performing hospitals were able to improve survival outcomes over time. Methods and Results: We used data from 84 089 adult patients with an in-hospital cardiac arrest from 166 hospitals with continuous participation in Get With The Guidelines–Resuscitation from 2012 to 2017. A 2-level hierarchical regression model was used to compute RSSRs during a baseline (2012–2013) and two follow-up periods (2014–2015 and 2016–2017). At baseline, hospitals were classified as top-, middle-, and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25%, respectively, on their RSSR metric during 2012 to 2013. We compared hospital performance on RSSR during follow-up between top, middle, and bottom-performing hospitals’ at baseline. During 2012 to 2013, 42 hospitals were identified as top-performing (median RSSR, 31.7%), 82 as middle-performing (median RSSR, 24.6%), and 42 as bottom-performing (median RSSR, 18.7%). During both follow-up periods, >70% of top-performing hospitals ranked in the top 50%, a substantial proportion remained in the top 25% of RSSR during 2014 to 2015 (54.6%) and 2016 to 2017 (40.4%) follow-up periods. Likewise, nearly 75% of bottom-performing hospitals remained in the bottom 50% during both follow-up periods, with 50.0% in the bottom 25% of RSSR during 2014 to 2015 and 40.5% in the bottom 25% during 2016 to 2017. While percentile rankings were generally consistent over time at ≈45% of study hospitals, ≈1 in 5 (21.4%) bottom-performing hospitals showed large improvement in percentile rankings over time and a similar proportion (23.7%) of top-performing hospitals showed large decline in percentile rankings compared with baseline. Conclusions: Hospital performance on RSSR during baseline period was generally consistent over 4 years of follow-up. However, 1 in 5 bottom-performing hospitals had large improvement in survival over time. Identifying care and quality improvement innovations at these sites may provide opportunities to improve in-hospital cardiac arrest care at other hospitals.

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