Abstract 55: Ventricular Fibrillation remains the Primary Presenting Rhythm: Results from the Wearable Cardioverter Defibrillator Human Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hao Wang ◽  
Wanchun Tang ◽  
Min-Shan Tsai ◽  
Yongqin Li ◽  
Max H Weil
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Clinical Studies ◽  
Human Study ◽  
Sudden Cardiac Arrest ◽  
Pulseless Electrical Activity ◽  
Progressive Decrease ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Initial Rhythm

Background. Clinical studies during the last 2 decades have demonstrated a progressive decrease in the incidence of ventricular fibrillation (VF) as the presenting rhythm in settings of out-of-hospital sudden cardiac arrest (SCA). In the present study, we investigated the initial rhythm of SCA from data recorded in a wearable cardioverter defibrillator (WCD) which collected these events in real time. Hypothesis. In settings of out-of-hospital SCA, VF remains the leading cause. Methods and Results. The incidence and the type of arrhythmias were determined by reviewing stored electrocardiograms in the WCDs. Seventy-four consecutive WCD recipients and 108 events were analyzed. Patients with a previously implanted ICD that required change due to infection were the most prevalent recipients of WCDs. Fifty-one percent were VF/VT patients and 43.8% were pulseless electrical activity (PEA) patients. VF/VT was the initial rhythm of SCA in 79.7% of patients and 86.1% of events while the PEA occurred in 20.3% of patients and 13.9% of events. 84.5% of patients survived VF/VT and 18.8% of patients survived PEA. There was no difference in the characteristics of patients with different initial rhythms. Conclusions. In out-of-hospital settings, VF remains the predominant initial rhythm when recorded immediately following SCA. .

scholarly journals The dependence of successful resuscitation on electrocardiographically documented cardiac rhythm in case of out-of-hospital cardiac arrest

Medicina ◽  
2007 ◽  
Vol 43 (10) ◽  
pp. 798 ◽  
Author(s):  
Nedas Jasinskas ◽  
Dinas Vaitkaitis ◽  
Vidas Pilvinis ◽  
Lina Jančaitytė ◽  
Gailutė Bernotienė ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiac Rhythm ◽  
Sudden Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Consensus Conference ◽  
Successful Resuscitation ◽  
Initial Rhythm ◽  
Hospital Deaths ◽  
One Year

Objective. To determine the influence of electrocardiographically documented cardiac rhythm during sudden cardiac arrest on successful resuscitation among out-of-hospital deaths in Kaunas city. Material and methods. An observational prospective study was conducted between 1 January, 2005, and 30 December, 2005, in Kaunas city with a population of 360 627 inhabitants. In this period, all cases of cardiac arrest were analyzed according to the guidelines of the Utstein consensus conference. Cardiac arrest (both of cardiac and noncardiac etiology) was confirmed in 72 patients during one year. Effective cardiopulmonary resuscitation was performed in 18 patients. Results. The total number of deaths from all causes in Kaunas during 1-year study period was 6691. Sixty-two patients due to sudden death of cardiac etiology were resuscitated by emergency medical services personnel. Return of spontaneous circulation was achieved in 11 patients. Ventricular fibrillation was observed in 33 (53.2%) patients. Asystole was present in 11 (17.7%) and other rhythms in 18 (29.1%) cases. Patients with ventricular fibrillation as an initial rhythm were more likely to be successfully resuscitated than patients with asystole. Conclusions. Ventricular fibrillation was the most common electrocardiographically documented cardiac rhythm registered during cardiac arrest in out-of-hospital settings. Ventricular fibrillation as a mechanism of cardiac arrest was associated with major cases of successful resuscitation.

P4167Non-shockable rhythm related sudden cardiac arrest in the community

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Sharifzadehgan ◽  
J Rischard ◽  
W Bougouin ◽  
F Dumas ◽  
V Waldmann ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Heart Disease ◽  
Sudden Cardiac Arrest ◽  
Pulseless Electrical Activity ◽  
Structural Heart Disease ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Coronary Syndrome ◽  
Shockable Rhythm ◽  
Initial Rhythm

Abstract Introduction A significant increase in the prevalence of sudden cardiac arrest (SCA) with non-shockable rhythm has been reported, related to asystole and pulseless electrical activity (PEA). Factors associated with non-shockable rhythm and the mode to the return of spontaneous circulation (ROSC) may help for a better understanding. Purpose We aimed to describe the frequency, characteristics and outcome of SCA related to non-shockable versus shockable rhythm in the community. Methods In this prospective ongoing, multicentre population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed. Initial rhythm was obtained from the EMS report and the initial recorded rhythm strip when available. Medical records for each SCA were reviewed by cardiologists to identify underlying aetiology and associated conditions. Results Among the 3,028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 2,904 patients had available information regarding initial rhythm at the time of EMS arrival. Among them, 1,314 patients (45.3%) presented with non-shockable rhythm: 1,109 (38.2%) cases with asystole, 197 (6.8%) with PEA and 8 (0.3%) with high degree atrioventricular block. Cases with non-shockable rhythm were older (60.6 vs. 57.4 years, P<0.001), with greater proportion of females (34.9 vs. 19.2%, P<0.001) and less proportion of family history of coronary artery disease or SCA. Proportion of warning symptoms prior to the SCA was higher among patients with non-shockable rhythm (74.3 vs. 64.9%, P<0.001) but the proportion of chest pain was lower (24.0 vs. 43.3%, P<0.001). Survival rate was much lower in non-shockable rhythm cases (7.2 vs. 42.3%, P<0.001). Among the 1,314 non-shockable cases eventually admitted alive to hospital, 1,022 (77.8%) did not require external defibrillation prior to ROSC, and a majority (91.7%) received adrenaline during resuscitation. In this subgroup, the main identified cardiac cause was acute coronary syndrome (45.3%), followed by chronic CAD (27.1%), structural non-ischemic heart disease (22.4%), and non-structural heart disease (5.2%). Conclusions Initial non-shockable rhythm is encountered in almost half of SCA cases admitted alive; mostly occurs in older patients with higher proportion of females. Over three quarters of these cases did not require external defibrillation prior to ROSC.

scholarly journals Sudden Cardiac Arrest in Hemodialysis Patients with Wearable Cardioverter Defibrillator

2013 ◽  
Vol 19 (3) ◽  
pp. 247-257 ◽  
Author(s):  
Chingping Wan ◽  
Charles A. Herzog ◽  
Wojciech Zareba ◽  
Steven J. Szymkiewicz
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Hemodialysis Patients ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator

PP002 Sudden Cardiac Arrest: Wearable Cardioverter-Defibrillator Therapy

2017 ◽  
Vol 33 (S1) ◽  
pp. 68-68
Author(s):  
Sabine Ettinger ◽  
Michal Stanak ◽  
Mirjana Huic ◽  
Romana Tandara Hacek ◽  
Darija Ercevic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Focus Group ◽  
Adverse Events ◽  
Cardiac Disease ◽  
Sudden Cardiac Arrest ◽  
The Body ◽  
Cochrane Library ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Wide Range

INTRODUCTION:Sudden cardiac arrest (SCA) is the most common cause of death in patients with coronary artery disease. Mostly, ventricular tachycardia (VT) and ventricular fibrillation (VF) are the underlying aetiology of SCA, which is claimed to be successfully treated by a novel therapy, a wearable cardioverter defibrillator (WCD, LifeVest®).The assessment, performed within the European Network for HTA (EUnetHTA), aimed to provide valid data on clinical effectiveness and safety of the WCD. Furthermore, the project intended to elicit patients views on aspects regarding their cardiac disease and the WCD therapy as well as to identify neglected outcomes.METHODS:A synthesis of evidence on the basis of a systematic literature search in Medline via Ovid, Embase, the Cochrane Library, and the Centre for Reviews and Dissemination (CRD) databases was performed. The search was complemented by citation tracking and handsearch.A face-to-face semi-structured focus group interview was performed with five cardiac disease patients in the scoping phase.RESULTS:Since no prospective controlled trials were found, no assessment of effectiveness could be performed. With regard to safety, five prospective studies were included, but the quality of the body of evidence was very low. Adverse events (AEs) reported were skin rash/itching (6 percent), false alarms (14 percent), palpitations/lightheadedness/fainting (9 percent) and discontinuation due to comfort/lifestyle issues (16-22 percent). Serious adverse events (SAEs) were inappropriate shocks (0-2 percent) and unsuccessful shocks (0-.7 percent). Frequency of SAEs leading to death was 0-.3 percent.Patients of the focus group reported that experiencing a sense of security was crucial to them. The WCD therapy was not considered an option for weeks or months, due to expected restrictions in living a ‘normal’ and secure life.CONCLUSIONS:No statement can be made about the device effectiveness – further research is needed. More data and more adequate reporting of AEs and SAEs are needed in order to establish the device safety. In particular, more data is needed for risk stratification of high risk patients in order to further narrow down the wide range of indications for the WCD use.

scholarly journals Health Technology Assessment on the use of the Wearable Cardioverter Defibrillator in Patients with Myocardial Infarction and with ICD Explant

2021 ◽  
Vol 22 (1S) ◽  
Author(s):  
Paolo Angelo Cortesi ◽  
Giovanni Luca Botto ◽  
Lucia D'Angiolella ◽  
Luciana Scalone ◽  
Roberto De Ponti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Health Technology Assessment ◽  
Implantable Cardioverter Defibrillator ◽  
Technology Assessment ◽  
Sudden Cardiac Arrest ◽  
Health Technology ◽  
Cardioverter Defibrillator ◽  
Wearable Cardioverter Defibrillator ◽  
Patients At Risk

The objective of the present work is to conduct a Health Technology Assessment (HTA) on the use of the Wearable Cardioverter Defibrillator (WCD) in patients at risk of Sudden Cardiac Arrest (SCA) following Myocardial Infarction (MI) or with an explanted Implantable Cardioverter Defibrillator (ICD).

scholarly journals In-hospital cardiac arrest resuscitation performed by the hospital emergency team: A 6-year retrospective register analysis at Danderyd University Hospital, Sweden

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1013 ◽  
Author(s):  
Hedwig Widestedt ◽  
Jasna Giesecke ◽  
Pernilla Karlsson ◽  
Jan G. Jakobsson
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Emergency Team ◽  
Factors Associated ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Background: Cardiac arrest requires rapid and effective handling. Huge efforts have been implemented to improve resuscitation of sudden cardiac arrest patients. Guidelines around the various parts of effective management, the chain of survival, are available. The aim of the present retrospective study was to study sudden in-hospital cardiac arrest (IHCA) and the outcomes of emergence team resuscitation in a university hospital in Sweden. Methods: The Swedish Cardiopulmonary Resuscitation Registry was used to access all reported cases of IHCA at Danderyd Hospital from 2012 through 2017. Return of spontaneous circulation (ROSC), discharge alive, 30-day mortality and Cerebral Performance Scales score (CPC) were analysed. Results: 574 patients with cardiac arrests were included in the study: 307 patients (54%) had ROSC; 195 patients (34%) were alive to be discharged from hospital; and 191 patients (33%) were still alive at day-30 after cardiac arrest. Witnessed cardiac arrests, VT/VF as initial rhythm and experiencing cardiac arrest in high monitored wards were factors associated with success. However, 53% of patients’ alive at day-30 had a none-shockable rhythm, 16% showed initially a pulseless electrical activity and 37% asystole. CPC score was available for 188 out of the 195 patients that were alive to be discharged: 96.5% of patients where data was available had a favourable neurological outcome, a CPC-score of 1 or 2 at discharge, and only 6 of these patients had a CPC-score of 3 or higher (3%). Conclusions: One third of patients with sudden IHCA were discharged from hospital and alive at day-30, a clear majority without cognitive deficit related to the cardiac arrest. High monitored care, witnessed cardiac arrest and shockable rhythm were factors associated with high success; however, more than half of surviving patients had initially a none-shockable rhythm.

Abstract 052: Improved Hospital Outcomes With Hypokalemia on Admission in Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Angelo de la Rosa ◽  
Manuel Tapia ◽  
Yong Ji ◽  
Basil Saour ◽  
Mikhail Torosoff
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Mortality ◽  
Electrical Activity ◽  
Therapeutic Hypothermia ◽  
Multivariate Logistic Regression Analysis ◽  
Pulseless Electrical Activity ◽  
Older Age ◽  
Chi Square

Purpose: We hypothesized that advanced circulatory compromise, as manifested by acidosis and hyperkalemia should be associated with worsened clinical outcomes in cardiac arrest patients treated with therapeutic hypothermia. Methods: Results of initial admission laboratory studies, medical history, and echocardiogram in 203 consecutive cardiac arrest patients (59 females, 59+/- 15 years old) undergoing therapeutic hypothermia were reviewed. Mortality was ascertained through hospital records. ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses were used. The study was approved by the institutional IRB. Results: Increased mortality was noted with older age, decreased admission pH, elevated admission lactate, lower admission hemoglobin, and pulseless electrical activity or asystole as presenting rhythms (Table). Admission hypokalemia and ventricular fibrillation/tachycardia were associated with improved hospital mortality (Table). Potassium was significantly lower in patients admitted with ventricular fibrillation/tachycardia (3.897+/-0.92) as compared to patients with asystole (4.674+/-1.377) or pulseless electrical activity (4.491+/-1.055 mEq/dL, p<0.0001). In multivariate logistic regression analysis, independent predictors of increased hospital mortality included increased admission potassium (OR 2.0, 95%CI 1.291-3.170, p=0.002)), older age (OR 1.04, 95%CI 1.007-1.071, p=0.017), admission PEA (OR 3.7, 95%CI 1.358-10.282, p=0.011 when compared to ventricular fibrillation/tachycardia) or asystole (OR 17.2, 95%CI 4.423-66.810, p<0.001 when compared to ventricular fibrillation/tachycardia); while decreased mortality was associated with higher hemoglobin (OR 0.8, 95%CI 0.665-0.997, p=0.047). Conclusions: Hyperkalemia, pulseless electrical activity, and asystole are predictive of increased hospital mortality in survivors of cardiac arrest. An association between low or low-normal potassium, observed VT-VF, and better outcomes is unexpected and may be used for prognostic purposes. More prospective investigations of mortality predictors in these critically ill patients are needed.

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