Abstract 2018: Cardiac Arrest in the Emergency Department: A Report from the National Registry of Cardiopulmonary Resuscitation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert G Kayser ◽  
Joseph P Ornato ◽  
Mary Ann Peberdy
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Discharge Rate ◽  
Traumatic Injury ◽  
Cerebral Performance Category ◽  
Secondary Analysis ◽  
National Registry ◽  
Performance Category ◽  
Neurologic Outcomes

Background: Little is known about cardiac arrests (CA) in the Emergency Department (ED). The objective of this study was to determine the characteristics of ED CA’s. Methods: Included were 60,852 adult, in-patient CA index events in the National Registry of Cardiopulmonary Resuscitation. Multiple regression analysis compared ED CA with those occurring in the ICU, telemetry, or general floors. Subgroup analysis examined traumatic vs. non-traumatic ED CA and ED CA occurring after a successful pre-hospital resuscitation (recurrent) vs. primary ED CA. Results: In multivariate analysis, ED location significantly predicted improved survival to discharge (OR 0.74, 95% CI[0.67–0.82], p<0.0001). Patients with CA occurring in the ED had better Cerebral Performance Category scores (ED 1.59, ICU 1.73, Tele 1.96, Floor 1.69, p<0.0001), shorter mean post-event length of stays (ED 8.6, ICU 17.5, Tele 16.5, Floor 14.2 days, p<0.0001) and were less likely to be declared DNR (ED 23.0%, ICU 31.7%, Tele 28.8%, Floor 31.8%, p<0.0001) than CA in other locations. Secondary analysis showed that ED patients with recurrent CA were less likely to survive to discharge (10.1% vs. 24.6%, p<0.0001) and were more likely to be declared DNR (27.9% vs. 22.2%, p<0.0006.) than primary ED CA. Mean length of stay for survivors in both groups was similar (8.85 vs. 8.54 days, p=ns). Major traumatic injury preceded 6.3% of all ED CA. Patients whose ED CA was related to traumatic injury were younger (46.2 vs. 65.0 years, p<0.001), more likely to be male (78.2% vs. 58.1, p<0.0001), less likely to have the CA caused by an arrythmia (23.6% vs. 32.5%, p<0.0008), and more likely to have the CA preceded by hypotension or shock (41.6% vs. 29.0%, p<0.0001) than ED patients whose CA was not due to traumatic injury. ED trauma CA patients had a significantly lower survival to discharge rate than ED patients whose CA was not due to trauma (7.5% vs. 23.8%, p<0.0001). Conclusions: ED CA patients are a unique population and have better survival and neurologic outcomes compared to patients in other hospital locations. Primary ED CA patients have a better chance of survival to discharge than those who re-arrest following a successful pre-hospital resuscitation. Traumatic ED CA patients have worse outcomes than non-traumatic CA.

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

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&lt;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&lt;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

scholarly journals Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Konrad Kirsch ◽  
Stefan Heymel ◽  
Albrecht Günther ◽  
Kathleen Vahl ◽  
Thorsten Schmidt ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
White Matter ◽  
Circulatory Arrest ◽  
Cerebral Performance Category ◽  
Time Interval ◽  
Performance Category ◽  
Neurologic Outcomes ◽  
Ischaemic Brain ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background This study aimed to assess the prognostic value regarding neurologic outcome of CT neuroimaging based Gray-White-Matter-Ratio measurement in patients after resuscitation from cardiac arrest. Methods We retrospectively evaluated CT neuroimaging studies of 91 comatose patients resuscitated from cardiac arrest and 46 non-comatose controls. We tested the diagnostic performance of Gray-White-Matter-Ratio compared with established morphologic signs of hypoxic-ischaemic brain injury, e. g. loss of distinction between gray and white matter, and laboratory parameters, i. e. neuron-specific enolase, for the prediction of poor neurologic outcomes after resuscitated cardiac arrest. Primary endpoint was neurologic function assessed with cerebral performance category score 30 days after the index event. Results Gray-White-Matter-Ratio showed encouraging interobserver variability (ICC 0.670 [95% CI: 0.592–0.741] compared to assessment of established morphologic signs of hypoxic-ischaemic brain injury (Fleiss kappa 0.389 [95% CI: 0.320–0.457]) in CT neuroimaging studies. It correlated with cerebral performance category score with lower Gray-White-Matter-Ratios associated with unfavourable neurologic outcomes. A cut-off of 1.17 derived from the control population predicted unfavourable neurologic outcomes in adult survivors of cardiac arrest with 100% specificity, 50.3% sensitivity, 100% positive predictive value, and 39.3% negative predictive value. Gray-White-Matter-Ratio prognostic power depended on the time interval between circulatory arrest and CT imaging, with increasing sensitivity the later the image acquisition was executed. Conclusions A reduced Gray-White-Matter-Ratio is a highly specific prognostic marker of poor neurologic outcomes early after resuscitation from cardiac arrest. Sensitivity seems to be dependent on the time interval between circulatory arrest and image acquisition, with limited value within the first 12 h.

scholarly journals (A152) Comparison of Load Distributing Band and Standard Cardiopulmonary Resuscitation in Patients Presenting with Cardiac Arrest to Emergency Department

2011 ◽  
Vol 26 (S1) ◽  
pp. s43-s43
Author(s):  
M.E. Ong ◽  
P. Sultana ◽  
S. Fook-Chong ◽  
A. Annitha ◽  
S.H. Ang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Number Needed To Treat ◽  
Performance Category ◽  
Traumatic Cardiac Arrest

ObjectiveTo compare resuscitation outcomes before and after switching from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR in a multi-center Emergency Departments (ED) trial.MethodsThis is a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. The intervention is change in the system from manual CPR to LDB-CPR at two Urban EDs. The main outcome measure is survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.ResultsA total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. Rates for ROSC were comparable with LDB-CPR (manual 22.4% vs. LDB 35.3%; adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 0.63-1.83). Survival to hospital admission was increased, Manual 14.2% vs. LDB 19.7%; adjusted OR, 2.50; 95% CI, 1.05-6.00. Survival to hospital discharge was increased Manual 1.3% vs. LDB 3.3%; adjusted OR, 3.99; 95% CI, 1.06-15.02. The number of survivors with Cerebral Performance Category 1 (good) (Manual 1 vs. LDB 12, p < 0.01) and Overall Performance Category 1 (good) (Manual 1 vs. LDB 10, p < 0.01) was also increased. The Number Needed to Treat (NNT) for 1 survivor was 52 (95% CI, 26-1000).ConclusionA resuscitation strategy using LDB-CPR in an ED environment was associated with improved survival to admission and discharge in adults with non-traumatic cardiac arrest.

scholarly journals Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

2020 ◽  
Author(s):  
June-sung Kim ◽  
Hyun-Jin Bae ◽  
Chang Hwan Sohn ◽  
Sung-Eun Cho ◽  
Jeongeun Hwang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Discharge Rate ◽  
Rank Correlation ◽  
Emergency Department Overcrowding ◽  
Neurologic Outcomes ◽  
Traumatic Cardiac Arrest ◽  
Presentation Time ◽  
Occupancy Rates ◽  
Hospital Cardiac Arrest

Abstract Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, association between emergency department crowding and occurrence of in-hospital cardiac arrest has not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic in-hospital cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest. Overall survival discharge rate was 24.6%, and 20.3% of patients showed favorable neurologic outcomes at discharge. Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Meanwhile, occupancy rates were not associated with the ED mortality. Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence. Adequate monitoring and managing the maximum occupancy rate would be important to reduce unexpected cardiac arrest.

scholarly journals Maximum emergency department overcrowding is correlated with occurrence of unexpected cardiac arrest

2020 ◽  
Author(s):  
June-sung Kim ◽  
Hyun-Jin Bae ◽  
Chang Hwan Sohn ◽  
Sung-Eun Cho ◽  
Jeongeun Hwang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Rank Correlation ◽  
Spontaneous Circulation ◽  
Emergency Department Overcrowding ◽  
Neurologic Outcomes ◽  
Traumatic Cardiac Arrest ◽  
Occupancy Rates ◽  
Hospital Cardiac Arrest

Abstract Background Emergency department overcrowding negatively impacts critically ill patients and could lead to the occurrence of cardiac arrest. However, associations between emergency department crowding and occurrence of both in-hospital cardiac arrest and out-of-hospital cardiac arrest have not been thoroughly investigated. This study aimed to evaluate the correlation between emergency department occupancy rates and incidence of in-hospital and out-of-hospital cardiac arrest. Methods A single-center, observational, registry-based cohort study was performed including all consecutive adult, non-traumatic cardiac arrest patients between January 2014 and June 2017. We used emergency department occupancy rates as a crowding index at time of presentation time of cardiac arrest and at the time of maximum crowding, and the average crowding rate for the duration of emergency department stay for each patient. To calculate incidence rate, we divided the number of arrest cases for each emergency department occupancy period by accumulated time. The primary outcome is association between the incidence of in-hospital cardiac arrest and out-of-hospital cardiac arrest and emergency department occupancy rates. Results During the study period, 629 adult, non-traumatic cardiac arrest patients were enrolled in our registry. Among these, 187 patients experienced in-hospital cardiac arrest and 442 patients had out-of-hospital cardiac arrest. In-hospital cardiac arrest patients compared to out-of-hospital cardiac arrest patients had a significantly higher return of spontaneous circulation rates (16.5% vs. 4.8%; P < .01) and better neurologic outcomes at discharge (cerebral performance category scales 4.7 vs. 4.0; P < .01). Emergency department occupancy rates were positively correlated with in-hospital cardiac arrest occurrence. Moreover, maximum emergency department occupancy in the critical zone had the strongest positive correlation with in-hospital cardiac arrest occurrence (Spearman rank correlation ρ = 1.0, P < .01). Out-of-hospital cardiac arrest incidence was negatively correlated with emergency department occupancy (ρ = -0.79, P = .04). Conclusion Maximum emergency department occupancy was strongly associated with in-hospital cardiac arrest occurrence, while occupancy rate was negatively correlated with out-of-hospital cardiac arrest incidence.

Outcome of Conventional Bystander Cardiopulmonary Resuscitation in Cardiac Arrest Following Drowning

2020 ◽  
Vol 35 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Joshua M. Tobin ◽  
William D. Ramos ◽  
Joel Greenshields ◽  
Stephanie Dickinson ◽  
Joseph W. Rossano ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Age Groups ◽  
Cerebral Performance Category ◽  
Age Group ◽  
Performance Category ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Group Survival ◽  
Bystander Cpr

AbstractIntroduction:The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning.Hypothesis/Problem:The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only.Methods:The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC).Results:Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10–6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01–2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86–2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91–1.84; P = .157).Conclusion:In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.

scholarly journals One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital

2015 ◽  
Vol 13 (2) ◽  
pp. 183-188 ◽  
Author(s):  
Cássia Regina Vancini-Campanharo ◽  
Rodrigo Luiz Vancini ◽  
Claudio Andre Barbosa de Lira ◽  
Maria Carolina Barbosa Teixeira Lopes ◽  
Meiry Fernanda Pinto Okuno ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Room ◽  
Cerebral Performance Category ◽  
Neurological Status ◽  
Performance Category ◽  
Emergency Room Patients ◽  
Initial Rhythm ◽  
One Year

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.

Abstract 204: Conventional vs. Compression-Only Cardiopulmonary Resuscitation for Geriatric Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hiroki Ueyama ◽  
Yosuke Homma ◽  
Hiroyasu Shimizu ◽  
Tetsuya Inoue ◽  
Hiraku Funakoshi
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Scale Score ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Category Scale ◽  
Performance Category ◽  
Adjusted Analysis ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Introduction: Compression-only cardiopulmonary resuscitation (CPR) and conventional CPR (30:2, chest compression and rescue breathing) performed by bystanders are known to have similar outcomes in adults. This study aimed to investigate if this difference is applicable in geriatric populations as well. Methods: We conducted a prospective observational study using the All-Japan Utstein Registry to enroll geriatric patients (≥75 years) who experienced out-of-hospital cardiac arrest that was witnessed by bystanders in Japan from January 1, 2009 to December 31, 2013. The primary outcome was favorable neurological function 1 month after the event, which was defined as a Cerebral Performance Category Scale score of 1 or 2. The secondary outcomes were return of spontaneous circulation (ROSC), 1-month survival, and favorable overall function 1 month after the event, which was defined as an Overall Performance Category Scale score of 1 or 2. Outcomes of compression-only CPR and conventional CPR were compared using multivariable logistic regression analyses. Results: Of the 58,072 enrolled patients, 13,248 (22.8%) received conventional CPR whereas 44,824 (77.2%) received compression-only CPR. Favorable neurological outcomes were achieved in 708 (5.3%) patients receiving CPR and 1799 (4.0%) patients receiving compression-only CPR. A crude analysis of neurologically favorable survival revealed superiority of conventional CPR [odds ratio (OR), 1.35; 95% confidence interval (CI), 1.24–1.48; P < 0.001]], but it was no longer statistically significant after multivariable adjustment (OR, 1.09; 95% CI, 0.93–1.27; P = 0.29). Similarly, multivariable adjusted analysis of favorable overall function survival showed no significant difference (OR, 1.08; 95% CI, 0.92–1.26; P = 0.38) between conventional and compression-only CPR. Conventional CPR demonstrated better outcomes in multivariable adjusted analysis of ROSC and 1 month survival (OR, 1.30; 95% CI, 1.22–1.40; P < 0.001 and OR, 1.13. 95% CI, 1.04–1.23; P = 0.003, respectively). Conclusions: The superiority of conventional CPR in geriatric populations was not proven. Thus, we conclude that compression-only CPR is an adequate means of resuscitation in geriatric populations.

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