Abstract 12747: Protein Profiling for Survival Outcome Prediction in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chien-Hua Huang ◽  
Min-Shan Tsai ◽  
Wei-Tien Chang ◽  
Hsin-Yun Hsu ◽  
Wen-Jone Chen
Keyword(s):  
Cardiac Arrest ◽  
Outcome Prediction ◽  
Characteristic Curve ◽  
Protein Profiling ◽  
Inflammatory Reactions ◽  
Shockable Rhythm ◽  
Multiple Biomarkers ◽  
High Prediction ◽  
Hospital Cardiac Arrest ◽  
Pai 1

Introduction: Outcome prediction is still a challenge for out-of-hospital cardiac arrest (OHCA) patients in early post-cardiac arrest period. Changes of protein expression after cardiac arrest and resuscitation could be biomarkers for outcomes prediction. Single biomarker can not reach adequate power to predict outcome due to the complexity of pathophysiological cascades in post-cardiac arrest period. Protein profiling can measure multiple biomarkers at a time point and can provide better information for outcome prediction. Hypothesis: Identify the association of survival to discharge outcome and biomarkers changes by protein profiling in cardiac arrest patients Methods: Total 99 adult non-traumatic OHCA patients with sustained ROSC were enrolled for the study. There were 45 patients survival to hospital discharge. Blood were sampled at 24 hours after cardiac arrest. Protein profiling for 21 different biomarkers, which included brain, heart, inflammatory reactions, oxidative stress and coagulation markers, was measured by suspension microarray assay. Clustering analyses were carried out using Multi-Experiment Viewer (MeV v4.8.1). Results: Heat maps were generated to visualize the Log2 values relative to median values of overall patient sample pool. Based on the performed statistical analysis to narrow down the biomarker panel, we investigated samples respectively by employing only the significant parameters for the Hierarchical Clustering (HCL) analysis. Nine candidate biomarkers (IL-6, IL-8, IL-10, MCP-1, MDA-LDL, Cystatin C, PAI-1, NT-Pro-BNP and S100B) identified respectively from samples pools were applied. The discrimination based on the selected parameters was 76.3% to be accurately clustered in HCL analysis. When adding these biomarkers into clinical variables (age, sex, Apache II, hypothermia, shockable rhythm, CPR duration), receiver-operating characteristic curve analysis showed high prediction power for survival to discharge (area under curve = 0.9378, p<0.01) Conclusion: Protein profiling with suspension microarray can demonstrate the pattern of biomarkers in various pathophysiological changes after cardiac arrest. It has the potential to help predicting the outcome in OHCA patients.

scholarly journals Predictive Value of Estimated Lean Body Mass for Neurological Outcomes after Out-of-Hospital Cardiac Arrest

2020 ◽  
Vol 10 (1) ◽  
pp. 71
Author(s):  
Sung Eun Lee ◽  
Hyuk Hoon Kim ◽  
Minjung Kathy Chae ◽  
Eun Jung Park ◽  
Sangchun Choi
Keyword(s):  
Cardiac Arrest ◽  
Critically Ill ◽  
Lean Body Mass ◽  
Body Mass ◽  
Multivariate Regression ◽  
Characteristic Curve ◽  
Cerebral Performance Category ◽  
High Body Mass Index ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background: Postcardiac arrest patients with a return of spontaneous circulation (ROSC) are critically ill, and high body mass index (BMI) is ascertained to be associated with good prognosis in patients with a critically ill condition. However, the exact mechanism has been unknown. To assess the effectiveness of skeletal muscles in reducing neuronal injury after the initial damage owing to cardiac arrest, we investigated the relationship between estimated lean body mass (LBM) and the prognosis of postcardiac arrest patients. Methods: This retrospective cohort study included adult patients with ROSC after out-of-hospital cardiac arrest from January 2015 to March 2020. The enrolled patients were allocated into good- and poor-outcome groups (cerebral performance category (CPC) scores 1–2 and 3–5, respectively). Estimated LBM was categorized into quartiles. Multivariate regression models were used to evaluate the association between LBM and a good CPC score. The area under the receiver operating characteristic curve (AUROC) was assessed. Results: In total, 155 patients were analyzed (CPC score 1–2 vs. 3–5, n = 70 vs. n = 85). Patients’ age, first monitored rhythm, no-flow time, presumed cause of arrest, BMI, and LBM were different (p < 0.05). Fourth-quartile LBM (≥48.98 kg) was associated with good neurological outcome of postcardiac arrest patients (odds ratio = 4.81, 95% confidence interval (CI), 1.10–25.55, p = 0.04). Initial high LBM was also a predictor of good neurological outcomes (AUROC of multivariate regression model including LBM: 0.918). Conclusions: Initial LBM above 48.98kg is a feasible prognostic factor for good neurological outcomes in postcardiac arrest patients.

scholarly journals Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041917
Author(s):  
Fei Shao ◽  
Haibin Li ◽  
Shengkui Ma ◽  
Dou Li ◽  
Chunsheng Li
Keyword(s):  
Cardiac Arrest ◽  
Urban Areas ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Term Survival ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

ObjectiveThe purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.DesignCross-sectional study.MethodsAdult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.ResultsOverall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).ConclusionSurvival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.

Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Meshe Chonde ◽  
Jeremiah Escajeda ◽  
Jonathan Elmer ◽  
Frank X Guyette ◽  
Arthur Boujoukos ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Inclusion Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Implementation Challenges ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Stay And Play ◽  
Load And Go ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.

scholarly journals Emergency dispatch process and patient outcome in bystander-witnessed out-of-hospital cardiac arrest with a shockable rhythm

2015 ◽  
Vol 22 (4) ◽  
pp. 266-272 ◽  
Author(s):  
Pamela V.C. Hiltunen ◽  
Tom O. Silfvast ◽  
T. Helena Jäntti ◽  
Markku J. Kuisma ◽  
Jouni O. Kurola
Keyword(s):  
Patient Outcome ◽  
Cardiac Arrest ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

scholarly journals Impact of cooling method on the outcome of initial shockable or non-shockable out of hospital cardiac arrest patients receiving target temperature management: a nationwide multicentre cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Makoto Watanabe ◽  
Tasuku Matsuyama ◽  
Hikaru Oe ◽  
Makoto Sasaki ◽  
Yuki Nakamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score Analysis ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Multivariable Logistic Regression Analysis ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Score Analysis ◽  
Hospital Cardiac Arrest ◽  
Cooling Methods

Abstract Background Little is known about the effectiveness of surface cooling (SC) and endovascular cooling (EC) on the outcome of out-of-hospital cardiac arrest (OHCA) patients receiving target temperature management (TTM) according to their initial rhythm. Methods We retrospectively analysed data from the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest registry, a multicentre, prospective nationwide database in Japan. For our analysis, OHCA patients aged ≥ 18 years who were treated with TTM between June 2014 and December 2017 were included. The primary outcome was 30-day survival with favourable neurological outcome defined as a Glasgow–Pittsburgh cerebral performance category score of 1 or 2. Cooling methods were divided into the following groups: SC (ice packs, fans, air blankets, and surface gel pads) and EC (endovascular catheters and any dialysis technique). We investigated the efficacy of the two categories of cooling methods in two different patient groups divided according to their initially documented rhythm at the scene (shockable or non-shockable) using multivariable logistic regression analysis and propensity score analysis with inverse probability weighting (IPW). Results In the final analysis, 1082 patients were included. Of these, 513 (47.4%) had an initial shockable rhythm and 569 (52.6%) had an initial non-shockable rhythm. The proportion of patients with favourable neurological outcomes in SC and EC was 59.9% vs. 58.3% (264/441 vs. 42/72), and 11.8% (58/490) vs. 21.5% (17/79) in the initial shockable patients and the initial non-shockable patients, respectively. In the multivariable logistic regression analysis, differences between the two cooling methods were not observed among the initial shockable patients (adjusted odd ratio [AOR] 1.51, 95% CI 0.76–3.03), while EC was associated with better neurological outcome among the initial non-shockable patients (AOR 2.21, 95% CI 1.19–4.11). This association was constant in propensity score analysis with IPW (OR 1.40, 95% CI 0.83–2.36; OR 1.87, 95% CI 1.01–3.47 among the initial shockable and non-shockable patients, respectively). Conclusion We suggested that the use of EC was associated with better neurological outcomes in OHCA patients with initial non-shockable rhythm, but not in those with initial shockable rhythm. A TTM implementation strategy based on initial rhythm may be important.

scholarly journals Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm

Resuscitation ◽  
2021 ◽  
Author(s):  
Bo Nees Iversen ◽  
Carsten Meilandt ◽  
Ulla Væggemose ◽  
Christian Juhl Terkelsen ◽  
Hans Kirkegaard ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Shockable Rhythm ◽  
Rhythm Analysis ◽  
Hospital Cardiac Arrest ◽  
Off Time

Abstract 236: Regional Incidence and Outcome of Out-of-Hospital Cardiac Arrest Associated with Overdose

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David D Salcido ◽  
Allison C Koller ◽  
Cesar D Torres ◽  
Aaron M Orkin ◽  
Rob H Schmicker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
North America ◽  
Prescription Drugs ◽  
Regional Variation ◽  
Spontaneous Circulation ◽  
Research Network ◽  
Shockable Rhythm ◽  
Statistics Canada ◽  
Population Counts ◽  
Hospital Cardiac Arrest

Introduction: The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The contribution of drug overdose (OD) to regional variation in the incidence and outcome out-of-hospital cardiac arrest (OHCA) is unclear. Objective: To estimate overall and regional variation in incidence and outcomes of emergency medical services (EMS)-treated OD-OHCA cases across North America. Methods: The Resuscitation Outcomes Consortium (ROC) is a clinical research network with 10 regional clinical centers in United States (US) and Canada that uses uniform methods for surveillance of all EMS-treated OHCA in participating regions. Cases of OHCA from 2006 to 2010 were reviewed for evidence of association with or without OD. Incidence of OD-OHCA was calculated as the number of OD-OHCA in a region per 100,000 cumulative person-years, using 2000 US Census and 2006 Statistics Canada population counts. Patient and EMS characteristics as well as outcome were described. Multiple logistic regression was used to describe the association between OD status on return of spontaneous circulation (ROSC) and survival to hospital discharge, while adjusting for case characteristics and consortium center. Results: Included were 56,272 cases of OHCA. Regional incidence of OD-OHCA varied between 0.5 and 2.7 per 100,000 person years (p<0.001), and proportion of OD-OHCA among all EMS-treated OHCA ranged from 0.9% to 3.8%. Table 1 shows outcomes and characteristics stratified by OD status; OD-OHCA were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-OD, OD-OHCA was associated with ROSC (OR: 1.55; 95%CI: 1.35-1.78) and survival (OR: 2.14; 95%CI: 1.72-2.65). Conclusions: OD-OHCA are a small proportion of all OHCA, although incidence varied up to 5-fold across regions. OD-OHCA were more likely to survive than non-OD-OHCA.

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