Abstract 46: Meta-analysis of Endotracheal Intubation Versus Supraglottic Airway Placement by Emergency Medical Services During Out-of-Hospital Cardiac Arrest

Objective: Patients frequently undergo advanced airway management during out of hospital cardiac arrest (OHCA) resuscitation attempts. Recent observational data has associated endotracheal intubation (ETI) with worse outcomes and unacceptable failure rates. Supraglottic airways (SGA) are easier to insert, but the comparative effectiveness of this intervention is unclear. The objective of this study was to analyze all available data comparing patient outcomes for these two airway methods in OHCA patients treated by emergency medical services (EMS). Methods: A dual-reviewer search was conducted in PubMed, Embase, and the Cochrane Database with a research librarian to identify all relevant peer-reviewed articles. Exclusion criteria were traumatic arrests, pediatric patients, physician/nurse intubators, rapid sequence intubation, video devices, devices solely obstructing the esophagus, and studies using identical datasets. Outcomes were evaluated in two categories: (1) Early survival (return of spontaneous circulation or survival to hospital admission), and (2) Late survival (survival to discharge or neurologically intact survival). Results were summarized using odds ratios and combined using meta-analytic techniques, Cochran’s Q test, and the random effects model. Results: From 3,454 titles, we reviewed 325 abstracts, yielding 5 observational studies that fulfilled all criteria, with 60,635 ETI patients and 246,506 SGA patients. Important covariates such as age, gender, initial cardiac rhythm, witness status, and bystander CPR, were similar between patient groups in all studies. Significant study-level heterogeneity was present for both early survival (I2 = 87.3%, p < 0.001) and late survival (I2 = 66.1%, p = 0.001). Patients who received ETI had statistically significant higher odds of early survival (odds ratio 1.37, 95% confidence interval 1.04-1.81) but similar odds of late survival (odds ratio 1.17, 95% confidence interval 0.86-1.61) compared to SGA. Conclusion: Patients with OHCA treated by EMS are more likely to achieve return of spontaneous circulation or survive to admission after ETI compared to SGA, but this does not change ultimate survival. A randomized control trial is needed to further evaluate these associations.

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Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618823349 ◽

2019 ◽

Vol 9 (6) ◽

pp. 599-607 ◽

Cited By ~ 1

Author(s):

Grímur Høgnason Mohr ◽

Kathrine B Søndergaard ◽

Jannik L Pallisgaard ◽

Sidsel Gamborg Møller ◽

Mads Wissenberg ◽

...

Keyword(s):

Cardiac Arrest ◽

Confidence Interval ◽

Odds Ratio ◽

Heart Rhythm ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Significant Difference ◽

Bystander Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest ◽

Diabetes Patients

Background: Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. Methods: Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001–2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. Results: In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66–0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48–0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). Conclusion: No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.

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Bag-Valve Mask versus Endotracheal Intubation in Out-of-Hospital Cardiac Arrest on Return of Spontaneous Circulation: A National Database Study

Open Access Emergency Medicine ◽

10.2147/oaem.s229356 ◽

2020 ◽

Vol Volume 12 ◽

pp. 43-46 ◽

Cited By ~ 1

Author(s):

Chaiyaporn Yuksen ◽

Phatthranit Phattharapornjaroen ◽

Woranee Kreethep ◽

Chonnakarn Suwanmano ◽

Chestsadakon Jenpanitpong ◽

...

Keyword(s):

Cardiac Arrest ◽

Endotracheal Intubation ◽

Spontaneous Circulation ◽

National Database ◽

Return Of Spontaneous Circulation ◽

Database Study ◽

Hospital Cardiac Arrest

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A five-year retrospective study of out-of-hospital cardiac arrest in a north-east Italian urban area

European Journal of Cardiovascular Nursing ◽

10.1177/1474515118786677 ◽

2018 ◽

Vol 18 (1) ◽

pp. 67-74 ◽

Cited By ~ 4

Author(s):

Matteo Danielis ◽

Martina Chittaro ◽

Amato De Monte ◽

Giulio Trillò ◽

Davide Durì

Keyword(s):

Cardiac Arrest ◽

Retrospective Study ◽

Cardiopulmonary Resuscitation ◽

Emergency Medical Service ◽

Odds Ratio ◽

Medical Service ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Emergency Medical ◽

Hospital Cardiac Arrest

Background: The reporting and analysing of data of out-of-hospital cardiac arrests encourages the quality improvement of the emergency medical services. For this reason, the establishment of a sufficiently large patient database is intended to allow analysis of resuscitation treatments for out-of-hospital cardiac arrests and performances of different emergency medical services. Aims: The aim of this study was to describe the demographics, characteristics, outcomes and determinant factors of survival for patients who suffered an out-of-hospital cardiac arrest. Methods: this was a retrospective study including all out-of-hospital cardiac arrest cases treated by the emergency medical service in the district of Udine (Italy) from 1 January 2010–31 December 2014. Results: A total of 1105 out-of-hospital cardiac arrest patients were attended by the emergency medical service. Of these, 489 (44.2%) underwent cardiopulmonary resuscitation, and return of spontaneous circulation was achieved in 142 patients (29%). There was a male predominance overall, and the main age was 72.6 years (standard deviation 17.9). Cardiopulmonary resuscitation before emergency medical service arrival was performed on 62 cases (44%) in the return of spontaneous circulation group, and on 115 cases (33%) in the no return of spontaneous circulation group ( p<0.024). Among the 142 cases of return of spontaneous circulation, 29 (5.9%) survived to hospital discharge. There was a smaller likelihood of return of spontaneous circulation when patients were female (odds ratio 0.61, 0.40–0.93). Patients who had an out-of-hospital cardiac arrest with an initial shockable rhythm (odds ratio 6.33, 3.86–10.39) or an age <60 years (odds ratio 2.91, 1.86–4.57) had a greater likelihood of return of spontaneous circulation. In addition, bystander cardiopulmonary resuscitation (odds ratio 1.56, 1.04–2.33) was associated with an increased chance of return of spontaneous circulation. Conclusion: The incidence of out-of-hospital cardiac arrest and survival rate lies within the known range. A wider database is necessary to achieve a better knowledge of out-of-hospital cardiac arrest and to drive future investments in the healthcare system.

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Abstract 346: Targeted Temperature Management is Associated with Improved Neurological Outcomes in Witnessed Out-of-hospital Cardiac Arrest Patients Who Achieve Early Return of Spontaneous Circulation

Circulation ◽

10.1161/circ.142.suppl_4.346 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Nobuyuki Enzan ◽

Ken-ichi Hiasa ◽

Kenzo Ichimura ◽

Masaaki Nishihara ◽

Takeshi Iyonaga ◽

...

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Propensity Score Matching ◽

Odds Ratio ◽

Spontaneous Circulation ◽

Temperature Management ◽

Return Of Spontaneous Circulation ◽

Neurological Outcomes ◽

Propensity Score Matching Analysis ◽

Hospital Cardiac Arrest

Background: Previous randomized controlled trials demonstrated the efficacy of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA) patients with both shockable and non-shockable rhythm. Real-world evidence for TTM using large OHCA database are scarce, and no study has investigated the relationship between TTM and time-to-return of spontaneous circulation (ROSC). Methods: The Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. Patients with witnessed non-traumatic OHCA who had been resuscitated and were in a coma were included. Eligible patients were divided into two groups according to the use of TTM. The primary outcome was defined as a Cerebral Performance Categories (CPC) Scale 1-2 at 30 days after OHCA. The propensity score matching analysis was used. The cubic spline analysis of the odds ratio of CPC 1-2 for TTM use by time-to-ROSC was performed. Results: Out of 34,754 patients with OHCA, 5,261 patients were included. The mean age was 70.3 years, and 3,417 (65.0%) were male. CPC 1-2 was more frequently observed in the TTM group in propensity score matching analysis (15.1% vs. 8.5%; odds ratio 1.92; 95% confidence interval 1.04-3.53; P=0.037). The cubic spline analysis showed that TTM was associated with CPC 1-2 in witnessed OHCA patients, which did not reach statistical significance in patients with time-to-ROSC longer than 50 min. Conclusions: TTM was associated with better neurological outcomes in witnessed OHCA patients, especially when patients were resuscitated within 50 min after collapse.

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Timing of inducing therapeutic hypothermia in patients successfully resuscitated after out-of-hospital cardiac arrest

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920958566 ◽

2020 ◽

pp. 102490792095856

Author(s):

Doo Youp Kim ◽

Jin Sup Park ◽

Sun Hak Lee ◽

Jeong Cheon Choe ◽

Jin Hee Ahn ◽

...

Keyword(s):

Cardiac Arrest ◽

Confidence Interval ◽

Therapeutic Hypothermia ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Flow Time ◽

Low Flow ◽

Return Of Spontaneous Circulation ◽

Neurological Outcomes ◽

Hospital Cardiac Arrest

Background: Therapeutic hypothermia can improve neurological status in cardiac arrest survivors. Objectives: We investigated the association between the timing of inducing therapeutic hypothermia and neurological outcomes in patients who experienced out-of-hospital cardiac arrest. Methods: We evaluated data from 116 patients who were comatose after return of spontaneous circulation and those who received therapeutic hypothermia between January 2013 and April 2017. The primary endpoint was good neurological outcomes during index hospitalization, defined as a cerebral performance category score of 1 or 2. Therapeutic hypothermia timing was defined as the duration from the return of spontaneous circulation to hypothermia initiation. We analyzed the effect of early hypothermia induction on neurological results. Results: In total, 112 patients were enrolled. The median duration to hypothermia initiation was 284 min (25th–75th percentile, 171–418 min). Eighty-two (69.5%) patients underwent hypothermia within 6 h, and 30 (25.4%) had good neurological outcomes. The rates of good neurological outcomes by hypothermia initiation time quartile (shortest to longest) were 28.3%, 34.5%, 14.8%, and 28.6% (p = 0.401). The good neurologic outcomes did not differ between hypothermia patients within 6 h or after (26.5% vs 26.7%, p = 0.986). Short low-flow time and bystander resuscitation were associated with good neurological outcomes (p = 0.044, confidence interval: 0.027–0.955), but the timing of hypothermia initiation was not (p = 0.602, confidence interval: 0.622–1.317). Conclusion: A shorter low-flow time was associated with good neurological outcomes in out-of-hospital cardiac arrest patients who experienced hypothermia. However, inducing hypothermia sooner, even within 6 h, did not improve the neurological outcomes. Thus, as current guidelines recommend, initiating hypothermia within 6 h of recovery of spontaneous circulation is reasonable.

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