Abstract 13027: Risk of Sudden Cardiac Arrest According to the Time of STEMI Occurrence: the e-MUST Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Nicole Karam ◽  
Sophie Bataille ◽  
Muriel Tafflet ◽  
Eloi Marijon ◽  
Jean Philippe Empana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Sudden Cardiac Arrest ◽  
Progressive Increase ◽  
Time Interval ◽  
Main Mode ◽  
Time Intervals ◽  
Circadian Change ◽  
Hospital Study ◽  
Suspected Acute Myocardial Infarction

Introduction: STEMI mortality decreased drastically during the last decades, and out-of-hospital sudden cardiac arrest (SCA) has become its main mode of death. The risk of out-of-hospital SCA according to the timing of STEMI occurrence has not been assessed. Hypothesis: The risk of SCA, prior to hospital admission, differs according to the timing of STEMI occurrence. Methods: Data were taken from a prospective pre-hospital study (e-MUST study) on all STEMI patients managed by emergency medical services in Paris and its suburbs between January 2006 and December 2010. In this area, emergency calls are routed to the closest dispatch center and regulated by physicians who send, in the field, an ambulance with a physician on board in case of suspected acute myocardial infarction. Pre-hospital EKGs are obtained for all patients and those presenting STEMI are included in the study. We assessed the rate of SCA, prior to hospital admission, according to the timing of STEMI occurrence (4 hours-time intervals starting at midnight). Results: Among the 8,112 STEMI patients enrolled (mean age (SD) 61.6 (14.3) years, 78% males), 452 patients (5.6%) developed out-of-hospital SCA. We observed significant circadian change in the rate of SCA per STEMI, with a progressive increase between 4am and 8pm, followed by a decrease between 8pm and 4am (P=0.0009). The peak rate of SCA per STEMI occurred in the 4pm-8pm time interval (7.7%), while the lowest rate was seen between 4am and 8am (4.2%) (Figure). Conclusions: The risk of STEMI-related SCA is almost 2-fold higher in STEMI occurring in the late afternoon hours. A better understanding of patients’ characteristics, circumstances of occurrence, and pre-hospital care is needed to eventually reduce the risk of SCA promptly after STEMI diagnosis in the field.

Abstract 19529: Risk of Sudden Cardiac Arrest According to the Month of STEMI Occurrence: The e-MUST Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Nicole Karam ◽  
Muriel Tafflet ◽  
Sophie Bataille ◽  
Eloi Marijon ◽  
Jean Philippe empana ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Cause Of Death ◽  
Sudden Cardiac Arrest ◽  
Temporal Changes ◽  
Pathophysiological Mechanisms ◽  
Hospital Study ◽  
Suspected Acute Myocardial Infarction

STEMI mortality decreased drastically during the last decades, and out-of-hospital sudden cardiac arrest (SCA) has become its main cause of death. The risk of SCA according to the month of STEMI occurrence has not been assessed. Hypothesis: The risk of SCA varies according to the month of STEMI occurrence. Methods: Data were taken from a prospective pre-hospital study (e-MUST study) on STEMI patients managed by emergency medical services in Paris and its suburbs between January 2006 and December 2010. In this area, emergency calls are routed to the closest dispatch center and regulated by physicians who send an ambulance with a physician on board in case of suspected acute myocardial infarction. Pre-hospital EKGs are obtained for all patients and those presenting STEMI are included in the study. We assessed and compared the rate of SCA according to the month of STEMI occurrence. Results: Among the 8112 STEMI patients enrolled (mean age (SD) 61.6years (14.3), 78% males), 452 patients (5.6%) developed out-of-hospital SCA. We observed significant temporal changes in the rate of SCA per STEMI over the year. The peak rate of SCA per STEMI occurred in June (8.7%), while the lowest rate was in December (3.45%) (Figure). Conclusions: The risk of SCA varies significantly according to the month of STEMI occurrence, with STEMI occurring in June being at the highest risk for SCA while those occurring in December have the lowest risk. A better understanding of the pathophysiological mechanisms of this difference is needed to eventually reduce the risk of out-of-hospital SCA after STEMI diagnosis.

Abstract P237: Common Genetic Variation in Caspase Enzymes and Survival of Sudden Cardiac Arrest

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Catherine O Johnson ◽  
Rozenn N Lemaitre ◽  
Nona Sotoodehnia ◽  
Barbara McKnight ◽  
Kenneth M Rice ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Genetic Variation ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
A Priori ◽  
Sudden Cardiac Arrest ◽  
Population Based ◽  
Minor Allele ◽  
P Value ◽  
Brain Resuscitation

Background: Reperfusion following ischemia due to sudden cardiac arrest (SCA) is necessary for survival, but results in additional injury to affected tissues. Regulation of apoptosis has been shown to be important in determining the extent of reperfusion injury. Caspases (CASP) are essential enzymes in the apoptotic cascade and we therefore hypothesized that genetic variation in these enzymes might influence cardiac and brain resuscitation after SCA. To test this, we examined three genes (CASP2, CASP3, CASP9) in a population-based study of SCA survival. Methods: Subjects (mean age 67, 80% male, of European descent) were out-of-hospital SCA patients found in ventricular fibrillation (VF) and attended by paramedics in King County, WA (n=1614). To investigate cardiac resuscitation, we compared subjects who survived to hospital admission (n=827) with those who did not (n=787); for brain resuscitation, we compared subjects who survived to hospital discharge (n=448) with those who did not (n=1166). Associations of 19 SNPs were examined using logistic regression comparing each additional copy of the minor allele. Based on a priori hypotheses, models were adjusted for: age; gender; time from 911 call to arrival of emergency medical services; whether the event was witnessed; occurred in public; and whether bystander CPR was administered. We used within-gene permutation tests to adjust p-values for multiple comparisons. Results: Two SNPs in CASP3 were associated with SCA survival. The A allele of rs4647688 (minor allele frequency (MAF) 0.20) was associated with lower rates of survival to hospital admission (OR (95% CI), adjusted p-value: 0.78 (0.65, 0.93), p =0.043). The T allele of rs2705897 (MAF 0.26) was associated with a higher rate of survival to hospital admission (1.27 (1.07, 1.51), p =0.049). These two SNPs are in almost complete linkage equilibrium (r 2 =0.091). No SNPs in CASP3 were significantly associated with survival to hospital discharge, and no SNPs in CASP2 or CASP9 were significantly associated with either outcome. Conclusions: CASP3 variants are associated with SCA survival in this population. Further work is needed to explore the effect of these variants on regulation of apoptosis during reperfusion following VF arrest, and to replicate these findings in other populations.

Abstract 19091: Prognosis of Patients With Out-of-hospital Refractory Cardiac Arrest Referred for Extracorporeal Life Support: An Observational Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cecile Ursat ◽  
Marie-Ange Tilliette ◽  
Charles Groizard ◽  
Margot Cassuto ◽  
Anna Ozguler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Spontaneous Circulation ◽  
Flow Time ◽  
Low Flow ◽  
Time Interval ◽  
Specific Situation ◽  
Time Intervals ◽  
Paris Area

Introduction: In case of no return of spontaneous circulation (ROSC) after conventional cardio-pulmonary resuscitation (CPR), out-of-hospital cardiac arrest (OHCA) patients could be referred for extracorporeal life support (ECLS). Guidelines have been published concerning this specific situation (1). The aim of our study was to describe the prognosis of OHCA patients and verify if referral to ECLS was compliant with these recommendations mainly studying time intervals (no-flow < 5 min, low-flow < 100 min). Methods: A prospective survey on OHCA referred to ECLS was implemented from 03/01/12 until 06/11/15 in an Emergency Medical Service (EMS) located in Paris area (France). This survey included 43 patients referred to hospital for ECLS. Variables were given as means and percentages. Results: Patients referred to ECLS were more often men (77%), with a mean age of 51 years old. Most of 43 OHCA occurred at home (51%), although 26% occurred on public area and 16% at workplace. In 40% of cases, CPR was performed by a witness and in 33% by a health professional. A first Basic Life Support ambulance arrived on scene within 7 min 50 sec, whereas EMS ambulance arrived on scene within 18 min 27 sec after OHCA. At EMS arrival on scene, patients were on asystole (44%), ventricular fibrillation (37%), and on spontaneous circulation (12%). The no-flow time interval was 4 min 10 sec on average (6 patients had a no-flow over 5 min) with 43% of patients with no no-flow. Low-flow time-interval was 44 min. External electric shock was delivered before EMS arrival on 21% of cases, and EMS itself delivered a shock in 40% of cases. Epinephrine was used for all patients, 10.35 mg on average. No patient survived OHCA after referral to ECLS. Discussion: Although this is a small series of 43 patients, no OHCA patient referred to ECLS survived. These results are mainly due to a non-shockable initial condition or too long no-flow time intervals. In order to improve the outcome and bring benefit to the proper expected patients through a cost-effective pathway, we released a reminder of the right recommendations in our EMS. (1) Riou B., Adnet F., Baud F et al. A. Recommandation sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Ann Fr Anesth Réanim 2009 ; 28 : 182-6.

Abstract 147: Rapid Responder Operating Times for Out-of-hospital Cardiac Arrest Using Three Automated External Defibrillator Models

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Mengqi Gao ◽  
Chenguang Liu ◽  
Dawn Jorgenson
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Operating Time ◽  
Sudden Cardiac Arrest ◽  
The United States ◽  
Automated External Defibrillator ◽  
Simulation Studies ◽  
Time Intervals ◽  
Shock Delivery ◽  
External Defibrillator

Background: Early defibrillation with an automated external defibrillator (AED) is crucial for improving the survival rate in out-of-hospital resuscitation from sudden cardiac arrest (SCA). Chance of survival decreases by 7% to 10% for every minute that defibrillation is delayed. While simulation studies have been used to assess AED usability factors, our objective was to report the actual operating time for three Philips AED models used in SCA responses. Methods: A convenience dataset recorded by Philips AEDs (HS1, FRx, or FR3) was obtained from Europe and the United States from 2007 - 2018. The HS1 is intended for minimally trained or untrained individuals, the FRx is for Basic Life Support (BLS), and the FR3 is for both BLS and Advanced Life Support (ALS) responders. A retrospective analysis was conducted to report the operating time intervals for cases where a shock was delivered after initial rhythm analysis. The study analyzed 90 HS1, 46 FRx and 32 FR3 cases. Results: Compared with HS1, both FRx (p < 0.001) and FR3 (p = 0.001) responders spent less time in placing pads on the patient after powering on the AED (Figure 1) as expected. Similarly, time intervals from the start of shock advised prompt to first shock delivery for FRx (p = 0.02) and FR3 (p < 0.01) are shorter than for HS1. Time from AED power-on to first shock was within 90 seconds in 74.4% (67 of 90) HS1 cases, 97.8% (45 of 46) FRx cases, and 100% (32 of 32) FR3 cases. On average, the FR3 and FRx responders were able to deliver the first shock within 48 seconds. Conclusions: The analysis shows that responders were able to quickly apply the AEDs and respond to the shock advisory prompt for all three AED models despite different training levels. This real-world performance is better than most reported simulation studies, however, this analysis cannot convey variety of activities that account for the differences in timing (e.g. pads applied before power-on, or compressions began before applying pads, etc.).

scholarly journals The Role of Automated External Defibrillators in Athletics

2009 ◽  
Vol 1 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Justin D. Rothmier ◽  
Jonathan A. Drezner
Keyword(s):  
Cardiac Arrest ◽  
Action Plan ◽  
Sudden Cardiac Arrest ◽  
Public Access ◽  
Time Interval ◽  
Athletic Programs ◽  
Early Defibrillation ◽  
Automated External Defibrillators ◽  
External Defibrillator

Context: Sudden cardiac arrest is the leading cause of death in young athletes. The purpose of this review is to summarize the role of automated external defibrillators and emergency planning for sudden cardiac arrest in the athletic setting. Evidence Acquisition: Relevant studies on automated external defibrillators, early defibrillation, and public-access defibrillation programs were reviewed. Recommendations from consensus guidelines and position statements applicable to automated external defibrillators in athletics were also considered. Results: Early defibrillation programs involving access to automated external defibrillators by targeted local responders have demonstrated a survival benefit for sudden cardiac arrest in many public and athletic settings. Conclusion: Schools and organizations sponsoring athletic programs should implement automated external defibrillators as part of a comprehensive emergency action plan for sudden cardiac arrest. In a collapsed and unresponsive athlete, sudden cardiac arrest should be suspected and an automated external defibrillator applied as soon as possible, as decreasing the time interval to defibrillation is the most important priority to improve survival in sudden cardiac arrest.

scholarly journals Can Mobile Videocall Assist Laypersons’ Use of Automated External Defibrillators? A Randomized Simulation Study and Qualitative Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jun Young Bang ◽  
Youngsuk Cho ◽  
Gyu Chong Cho ◽  
Jongshill Lee ◽  
In Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Time Interval ◽  
Mobile Video ◽  
Time Intervals ◽  
Automated External Defibrillators ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Voice Calls ◽  
Hospital Cardiac Arrest

Background and Importance. The rate of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) has increased rapidly in the past 10 years. However, laypersons’ use of automated external defibrillator (AED) is still low in comparison with bystander CPR. Objective. To investigate the feasibility of mobile videocall guidance to facilitate AED use by laypersons. Design, setting, and participants. A total of 90 laypersons were randomized into three groups: the mobile video call-guided, voice call-guided, and non-guided groups. Participants were exposed to simulated cardiac arrest to use an AED, and guided by video calls, voice calls, or were not guided. We recorded the simulation experiments as a videoclip, and other researchers who were blinded to the simulation assessed the performance according to the prespecified checklist after simulations. Outcomes measure and analysis. We compared the performance score and time intervals from AED arrival to defibrillation among the three groups and analyzed the common errors. Results. There was no significant difference among the three groups in terms of baseline characteristics. Performance scores in the checklist for using AED were higher in the mobile video call-guided group, especially in the category of “Power on AED” and “Correctly attaches pads” than in the other groups. However, the time interval to defibrillation was significantly longer in the mobile video call-guided group. Conclusions. Mobile video call guidance might be an alternative method to facilitate AED use by laypersons. Therefore, further well-designed research is needed to evaluate the feasibility of this approach in OHCA.

scholarly journals Reduction of Breast Cancer Treatment Delay as a Result of Efforts Carried Out by Two Brazilian NGOs

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 39s-39s
Author(s):  
M. Andrade ◽  
T. Santos ◽  
L. Andrade ◽  
M. Oliveira ◽  
K. Gomes ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hospital Admission ◽  
Patient Flow ◽  
Medical Consultation ◽  
Time Interval ◽  
Time Intervals ◽  
Cox Regression Analysis ◽  
Treatment Comparison ◽  
Reference Hospital ◽  
The Impact

Background: Brazilian breast cancer patients present disease often at advanced stages (III, IV). Previous studies indicated that system delay is a causal factor of bad prognosis and increased mortality rate. In the state of Paraíba, northeast of Brazil, two non-governmental organizations (NGOs) Américas Amigas and Mulheres de Peito de Campina Grande (MLDP), promote faster access to treatment by donating diagnostic mammography and biopsies as well as anatomo-histopathological and immunohistochemical analysis. Aim: The current study aimed at evaluating the effectiveness of the assistance provided by both NGOs and comparing patient flow between HNL and FAP, two reference cancer centers in João Pessoa and Campina Grande, respectively. Methods: Time-to-treatment was analyzed for different time intervals between first medical consultation and initiation of treatment. Comparison was performed between three groups of patients: 40 patients from Hospital Napoleão Laureano (HNL) in João Pessoa; 80 patients from Fundação Assistencial da Paraíba (FAP) in Campina Grande and 15 patients from FAP, who received support from the NGOs. Kaplan-Meier analysis was performed to compare time-intervals among the groups. To estimate the impact of socioeconomic variables Cox regression analysis was performed. Results: Mean time-interval between first medical consultation and hospital admission was 135 (SD=21.0), 370 (SD=73.7) and 515 (SD=36.6) days, for patients of HNL, MLDP and FAP, respectively ( P = 0.0021). Time intervals analyzed for patients within the FAP hospital, between first medical consultation and hospital admission, tended to be shorter for patients who were assisted by the NGOs, compared with those who did not receive any assistance from the NGOs. Patients who had consulted specialized oncological health services beforehand had an increased chance (HZ=2.32; 95% CI: 1.17-4.60; P = 0.016) of being admitted at the reference hospital within 90 days after the first medical consultation, compared with those who had not consulted such specialized services. There were no significant differences between HNL and FAP, regarding the time interval between hospital admission and treatment initiation ( P = 0.21). Conclusion: The assistance to patients provided by the two NGOs, aimed at speeding up the diagnosis process, accelerated patient flow between first medical consultation and admission at the hospitals. Regarding HNL, patients from the inland had been sent by primary health units in their municipalities, directly to the cancer reference hospital in João Pessoa, without being referred to an in-between health service. Such procedure explains the variation of time intervals when admissions at FAP and HNL are compared. The results of the current study indicate that by providing faster breast cancer diagnosis, the NGOs’ mediation can significantly improve patient flow.

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