Abstract P97: Standardized Post Resuscitation Care including Therapeutic Hypothermia for Patients with Non-VF Arrests

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Oystein Tomte ◽  
Tomas Draegni ◽  
Dag Jacobsen ◽  
Arild Mangschau ◽  
Kjetil Sunde
Keyword(s):  
Therapeutic Hypothermia ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Favorable Outcome ◽  
External Cooling ◽  
Care Protocol ◽  
Endovascular Cooling ◽  
Th 16 ◽  
Survival Potential ◽  
Cerebral Event

Introduction: Whether therapeutic hypothermia (TH) improves survival after out-of-hospital cardiac arrest (OHCA) with initial asystole (AS) or pulseless electrical activity (PEA) is still controversial. At our hospital, revived OHCA patients follow the same standardized post resuscitation care protocol, if active treatment is desired. This includes TH, irrespectively of initial rhythm. Thus, we wanted to report the outcome for our OHCA patients of non-VF origin. Methods: Since September 2003 all OHCA patients admitted to our hospital have been registered in a database. All patients with initial AS or PEA admitted to the Intensive Care Unit (ICU), or ward, between September 2003 and July 2007 were included. Favorable outcome is defined as a Cerebral Performance Category (CPC) of 1–2. Results: Altogether 58 patients, all comatose, with a median age of 55 (range 19 –90 years), were registered. Cardiac etiology was present in 24 patients (41%), half of which had a myocardial infarction. Among the 34 patients (59%) with non-cardiac etiology, 15 were intoxications (44%), seven had asphyxia after respiratory failure (21%), five had suffered a cerebral event (15%), three drowned (9%), one had a pulmonary embolism (3%), and three causes remained unidentified. Overall, 37 patients (67%) were treated with TH; 16 (43%) received external cooling (Arctic Sun, Medivance), 13 (35%) endovascular cooling (Coolgard, Alsius Corporation) and eight (22%) other external cooling, all methods combined with initial ice cold fluids/ice packs. Median time in ICU was three days (range 0 –19 days). Eleven patients (19%) were discharged alive from hospital (cardiac etiology in four, 36%). Nine patients (16%) had a favorable outcome, and two patients (3%) had CPC 3. Conclusion: After implementation of standardized post resuscitation care including TH, we found a 16% favorable survival among those admitted after non-VF OHCA, demonstrating a survival potential also for these patients.

scholarly journals Therapeutic Hypothermia after Cardiac Arrest: Experience at an Academically Affiliated Community-Based Veterans Affairs Medical Center

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Maulik P. Shah ◽  
Leslie Zimmerman ◽  
Jean Bullard ◽  
Midori A. Yenari
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Medical Center ◽  
Cerebral Performance Category ◽  
Case Series ◽  
Pulseless Electrical Activity ◽  
Community Setting ◽  
Veterans Affairs ◽  
Community Based ◽  
Mean Time

At laboratory and clinical levels, therapeutic hypothermia has been shown to improve neurologic outcomes and mortality following cardiac arrest. We reviewed each cardiac arrest in our community-based Veterans Affairs Medical Center over a three-year period. The majority of cases were in-hospital arrests associated with initial pulseless electrical activity or asystole. Of a total of 100 patients suffering 118 cardiac arrests, 29 arrests involved comatose survivors, with eight patients completing therapeutic cooling. Cerebral performance category scores at discharge and six months were significantly better in the cooled cohort versus the noncooled cohort, and, in every case except for one, cooling was offered for appropriate reasons. Mean time to initiation of cooling protocol was 3.7 hours and mean time to goal temperature of 33∘C was 8.8 hours, and few complications clearly related to cooling were noted in our case series. While in-patient hospital mortality of cardiac arrest was high at 65% mortality during hospital admission, therapeutic hypothermia was safe and feasible at our center. Our cooling times and incidence of favorable outcomes are comparable to previously published reports. This study demonstrates the feasibility of implementing, a cooling protocol a community setting, and the role of neurologists in ensuring effective hospital-wide implementation.

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.

Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Furqan B Irfan ◽  
Zain A Bhutta ◽  
Tooba Tariq ◽  
Loua A Shaikh ◽  
Pregalathan Govender ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Incidence Rate ◽  
Hospital Discharge ◽  
Middle Eastern ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Final Analysis ◽  
National Registry ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

scholarly journals Prognostic Value of the Neurological Examination in Cardiac Arrest Patients After Therapeutic Hypothermia

2017 ◽  
Vol 8 (2) ◽  
pp. 66-73 ◽  
Author(s):  
Elizabeth A. Matthews ◽  
Jessica Magid-Bernstein ◽  
Evie Sobczak ◽  
Angela Velazquez ◽  
Cristina Maria Falo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Neurological Examination ◽  
Prognostic Value ◽  
Strong Predictor ◽  
Cerebral Performance Category ◽  
Light Response ◽  
Columbia University ◽  
Predictive Values ◽  
Poor Outcome

Objectives: Current prognostication guidelines for cardiac arrest (CA) survivors predate the use of therapeutic hypothermia (TH). The prognostic value and ideal timing of the neurological examination remain unknown in the setting of TH. Design: Patients (N = 291) admitted between 2007 and 2015 to Columbia University intensive care units for TH following CA had neurological examinations performed on days 1, 3, 5, and 7 postarrest. Absent pupillary light response (PLR), absent corneal reflexes (CRs), and Glasgow coma scores motor (GCS-M) no better than extension were considered poor examinations. Poor outcome was recorded as cerebral performance category score ≥3 at discharge and 1 year. Predictive values of examination maneuvers were calculated for each time point. Main Results: Among the 137 survivors to day 7, sensitivities and negative predictive values were low at all time points. The PLR had false positive rates (FPRs) of 0% and positive predictive values (PPV) of 100% from day 3 onward. For the CR and GCS-M, the FPRs decreased from day 3 to 5 (9% vs 3%; 21% vs 9%), while PPVs increased (91% vs 96%; 90% vs 95%). Excluding patients who died due to withdrawal of life-sustaining therapy (WLST) did not significantly affect FPRs or PPVs, nor did assessing outcome at 1 year. Conclusions: A poor neurological examination remains a strong predictor of poor outcome, both at hospital discharge and at 1 year, independent of WLST. Following TH, the predictive value of the examination is insufficient at day 3 and should be delayed until at least day 5, with some additional benefit beyond day 5.

scholarly journals Therapeutic Hypothermia for Refractory Status Epilepticus

2015 ◽  
Vol 42 (4) ◽  
pp. 221-229 ◽  
Author(s):  
Frederick A. Zeiler ◽  
Kaitlin J. Zeiler ◽  
Jeanne Teitelbaum ◽  
Lawrence M. Gillman ◽  
Michael West
Keyword(s):  
Clinical Trials ◽  
Status Epilepticus ◽  
Therapeutic Hypothermia ◽  
Refractory Status Epilepticus ◽  
Cochrane Library ◽  
Seizure Reduction ◽  
Refractory Status ◽  
External Cooling ◽  
Grade Methodology ◽  
Clinical Trials Registry

AbstractBackground: Our goal was to perform a systematic review of the literature on the use of therapeutic hypothermia for refractory status epilepticus (RSE) and its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to May 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated by two independent reviewers, using both the Oxford and GRADE methodology. Results: Overall, 13 studies were identified, with 10 manuscripts and 3 meeting abstracts. A total of 40 patients were treated. The common target temperature was 33 degrees Celsius, sustained for a median 48 hours. Patients displayed a 62.5%, 15% and 22.5% rate of seizure cessation, seizure reduction, and failure of treatment respectively. External cooling was utilized in the majority of cases. Deep venous thrombosis, coagulopathy and infections were the commonly reported complications. Two ongoing clinical trials were identified. Conclusions: Oxford level 4, GRADE D evidence exists to support the use of therapeutic hypothermia to control seizures in RSE. Further prospective study is warranted.

scholarly journals Standardized visual EEG features predict outcome in patients with acute consciousness impairment of various etiologies

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Michael Müller ◽  
Andrea O. Rossetti ◽  
Rebekka Zimmermann ◽  
Vincent Alvarez ◽  
Stephan Rüegg ◽  
...  
Keyword(s):  
Clinical Features ◽  
Cerebral Performance Category ◽  
Classification Performance ◽  
Training Data ◽  
Favorable Outcome ◽  
Performance Category ◽  
Overall Performance ◽  
Consciousness Impairment ◽  
Favorable Functional Outcome ◽  
Eeg Features

Abstract Background Early prognostication in patients with acute consciousness impairment is a challenging but essential task. Current prognostic guidelines vary with the underlying etiology. In particular, electroencephalography (EEG) is the most important paraclinical examination tool in patients with hypoxic ischemic encephalopathy (HIE), whereas it is not routinely used for outcome prediction in patients with traumatic brain injury (TBI). Method Data from 364 critically ill patients with acute consciousness impairment (GCS ≤ 11 or FOUR ≤ 12) of various etiologies and without recent signs of seizures from a prospective randomized trial were retrospectively analyzed. Random forest classifiers were trained using 8 visual EEG features—first alone, then in combination with clinical features—to predict survival at 6 months or favorable functional outcome (defined as cerebral performance category 1–2). Results The area under the ROC curve was 0.812 for predicting survival and 0.790 for predicting favorable outcome using EEG features. Adding clinical features did not improve the overall performance of the classifier (for survival: AUC = 0.806, p = 0.926; for favorable outcome: AUC = 0.777, p = 0.844). Survival could be predicted in all etiology groups: the AUC was 0.958 for patients with HIE, 0.955 for patients with TBI and other neurosurgical diagnoses, 0.697 for patients with metabolic, inflammatory or infectious causes for consciousness impairment and 0.695 for patients with stroke. Training the classifier separately on subgroups of patients with a given etiology (and thus using less training data) leads to poorer classification performance. Conclusions While prognostication was best for patients with HIE and TBI, our study demonstrates that similar EEG criteria can be used in patients with various causes of consciousness impairment, and that the size of the training set is more important than homogeneity of ACI etiology.

Abstract 11816: Sustained Ventricular Fibrillation During CPR as the Strongest Predictor for the Favorable Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients; The Multicenter Prospective Study of SAVE-J

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takahiro Nakashima ◽  
Yoshio Tahara ◽  
Satoshi Yasuda ◽  
Naoto Morimura ◽  
Ken Nagao ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Initial Rhythm ◽  
Group A ◽  
Group B ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be effective in out-of-hospital cardiac arrest (OHCA) patients in whom ventricular fibrillation (VF) as an initial rhythm were refractory to conventional cardiopulmonary resuscitation (CPR). However, it remains unclear whether ECPR is effective even though cardiac rhythm would change from VF to non-VF during CPR. Methods: This multicenter prospective observational study was conducted in 46 hospitals. A total of 457 patients with OHCA aged 20-74 years in whom initial rhythm was VF and the duration from collapse to hospital arrival was within 45 minutes were originally registered. After given CPR for more than 15 minutes in hospital, these patients received combination therapy with ECPR including therapeutic hypothermia (TH), or not received. The patients underwent ECPR (n=250) were classified into the following 2 groups according to rhythm changes during CPR; Group-A (sustained VF; n=127) and Group-B (changing from VF initially to non-shockable rhythm; n=123). The endpoint was a favorable outcome defined as Cerebral Performance Category 1-2 at 6 months after collapse. Results: There were no significant differences of age, sex, time from collapse to ECPR start and the rate of TH between the 2 groups. The rate achieving favorable outcome was significantly higher in Group-A than Group-B. (19.7% vs. 3.3%, p<0.001) (Figure1). When focusing on sustained VF (Group-A), the rate achieving favorable outcome improved about 5.5-fold by ECPR (ECPR, n=127; 19.7% vs. non-ECPR, n=55; 3.6%, p<0.001) (Figure2). In the multivariate logistic-regression analysis, sustained VF during CPR was the strongest predictor for the favorable outcomes among the pre-hospital parameters including age, bystander CPR and time from collapse to ECPR (Odds ratio 4.43, p=0.018). Conclusions: These findings indicates that the patients with sustained VF seem to be a particular population that could merit ECPR.

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