Abstract 16996: Controlled Pauses (“Stutter”) CPR Did Not Improve ROSC or 4-hour Survival in a Porcine Model of VF-induced Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Esibov ◽  
Tyson G Taylor ◽  
Sharon B Melnick ◽  
Fred W Chapman ◽  
Gregory P Walcott
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Porcine Model ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Survival Rates ◽  
Data Gathering ◽  
Aortic Pressure ◽  
Spontaneous Circulation ◽  
Mechanical Cpr

Introduction: Ischemic post-conditioning (IPC) has shown promise in mitigating ischemia-reperfusion injury. Controlled pauses during CPR (CP-CPR) following cardiac arrest (CA) and prolonged downtime may help invoke IPC mechanisms and have been shown to improve neurological outcome in swine. We tested whether CP-CPR would improve return of spontaneous circulation (ROSC) and/or 4-hr survival rates, compared with standard CPR from a mechanical chest compression device (M-CPR), following prolonged downtime in a porcine model of ventricular fibrillation (VF)-induced CA. Methods: Twenty anesthetized and instrumented pigs were block randomized to two protocols. Following 10 min of VF, mechanical CPR was initiated (100 comp/min, 50% duty cycle, 2 inch depth). Over the first 5 minutes of CPR, the M-CPR protocol group received continuous chest compressions, while the CP-CPR protocol included four 20-sec pauses in compressions starting at 40, 100, 160, and 220 sec. All other interventions were the same in the two groups. After 5 minutes, a first shock was delivered during a pause. If the shock failed to convert to a perfusing rhythm for ≥ 30 s with a systolic aortic pressure (sAoP) ≥ 50 mmHg for at least the first three contiguous sAoP values, CPR was continued in 2 min cycles, followed by a shock (if indicated) at the end of each cycle, for up to 10 cycles. As soon as these criteria were met between two CPR cycles, ROSC was documented and a post-resuscitation protocol was initiated. During the post-resuscitation protocol, inotropic agents were provided as needed to maintain sAoP ≥ 50 mmHg. Survival was declared if the sAoP was maintained above threshold for 4 hrs following ROSC. Results: Nineteen animals were successfully instrumented for data gathering (9 CP-CPR, 10 M-CPR). In the CP-CPR and M-CPR groups respectively, 3/9 (33%) vs. 5/10 (50%) achieved ROSC (p = 0.46); when ROSC was achieved, time to ROSC was 7.7±1.2 min vs. 5.8±1.1 min (p = 0.08). All animals that achieved ROSC survived to 4 hours. Conclusions: In a porcine model of CA following prolonged VF, CP-CPR did not improve ROSC or 4-hr survival. The trend towards delayed time to ROSC suggests controlled pauses may impair initial resuscitation, even if they ultimately improve neurological outcome. Further studies are warranted.

Abstract P118: Influence of a Sulfide Donor on Resuscitability and Neurological Outcome in a Porcine Model of Prolonged Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthias Derwall ◽  
Aysegül Cizen ◽  
Celine Loewer ◽  
Maren Westerkamp ◽  
Nora Schnorrenberger ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pulmonary Artery ◽  
Neurological Outcome ◽  
Porcine Model ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Arterial Line ◽  
Hemodynamic Variables ◽  
Pulmonary Capillary ◽  
Wedge Pressure

Introduction: Hydrogen sulfide (H2S) protects vital organs and promotes survival in ischemia-reperfusion injury. Hypothesis: H2S increases resuscitability and neurological outcome in a porcine model of cardiac arrest (CA). Methods: 16 pigs were instrumented with an arterial line and a pulmonary artery catheter to measure mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWCP) before CA was electrically induced and left untreated for 10 minutes. One minute after starting cardiopulmonary resuscitation (CPR), animals were randomized to intravenous bolus injection of 1mg/kg of a liquid donor of H2S (Na2S; IK-1001, Ikaria, Clinton, NJ), followed by continuous infusion of 1mg/kg/h for two hours or placebo. After a total of 6 minutes of CPR defibrilation was attempted. Surviving animals were assessed for neurological outcome on four postoperative days using a neurological deficit score (NDS). Results: In both groups 50% of the animals could be initially resuscitated. Hemodynamic variables did not differ at baseline (i.e. before CA). However, H2S treated animals showed significantly lower MAP, MPAP and PCWP 60 minutes post CPR. PCWP remained significantly lower after 2, 3 and 4 hours. Two animals in the H2S group died before day four. Furthermore, H2S animals performed worse on the NDS at all time points after CPR (Time point - H2S vs. Placebo: +1 − 79 vs. 84/+2 − 74 vs. 89/+3 − 72 vs. 88/+4 71 vs. 88). Conclusion: In this pilot study, H2S at a dose of 1 mg/kg did not improve resuscitability and worsened post CPR hemodynamics and neurological outcome.

Abstract 138: Remote Ischemic Postconditioning Alleviates Postresuscitation Inflammatory Response and Pulmonary Edema in a Porcine Model of Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jiefeng Xu ◽  
Sen Ye ◽  
Zilong Li ◽  
Moli Wang ◽  
Zhengquan Wang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Inflammatory Response ◽  
Pulmonary Edema ◽  
Porcine Model ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Limb Ischemia ◽  
Multiple Organ ◽  
Control Group ◽  
Lung Water

Introduction: Systemic ischemia-reperfusion injury produced by CA and resuscitation can result in severe post-cardiac arrest syndrome; which includes systemic inflammatory response and multiple organ dysfunction syndrome such as acute pulmonary edema. We previously demonstrated that remote ischemic post-conditioning (RIpostC) improved post-resuscitation myocardial and cerebral function in a rat model of CA. In this study, we investigated the effects of RIpostC on inflammatory response and pulmonary edema after CPR in a porcine model. Hypothesis: RIpostC would alleviate post-resuscitation inflammatory response and pulmonary edema in a porcine model of CA. Methods: Fourteen male domestic pigs weighing 37 ± 2 kg were utilized. Ventricular fibrillation was electrically induced and untreated for 10 mins. The animals were then randomized to receive RIpostC or control. Coincident with the start of CPR, RIpostC was induced by four cycles of 5 mins of limb ischemia and then 5 mins of reperfusion. Defibrillation was attempted after 5 mins of CPR. The resuscitated animals were monitored for 4 hrs and observed for an additional 68 hrs. Results: Six of the seven animals in each group were successfully resuscitated. After resuscitation, significantly lower levels of tumor necrosis factor-α and interleukin-6 were measured in the animals that received RIpostC when compared with the control group. Post-resuscitation extra-vascular lung water index was lower in the RIpostC group than in the control group; in which the differences were significant at 2,3 and 4 hrs (Table). Conclusion: In a porcine model of CA, RIpostC significantly alleviates post-resuscitation inflammatory response and pulmonary edema.

Abstract P15: Periodic Acceleration (pGz) Preconditioning in Swine Increases Endothelial Derived NO and Phosphorylated eNOS via Akt Pathway

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jose A Adams ◽  
Jaqueline Arias ◽  
Jorge Bassuk ◽  
Heng Wu ◽  
Arkady Uryash ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Myocardial Stunning ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Spontaneous Circulation ◽  
Akt Pathway ◽  
Phosphorylated Akt ◽  
Manual Chest Compression ◽  
Periodic Acceleration ◽  
Pulsatile Shear Stress

Periodic acceleration (pGz) is the motion of the supine body using a motorized platform (3Hz & ±0.4G). pGz produces pulsatile shear stress increasing release of endothelial derived NO (eNO) which, also decreases myocardial stunning and improves outcomes from ventricular fibrillation (VF) cardiac arrest. Preconditioning with pGz (PRE-pGz) prior to VF cardiac arrest ameliorates global post resuscitation cardiac dysfunction and reduces arrhythmias. To test whether pGz and PRE-pGz increase eNOS and phosphorylated eNOS (p-eNOS) via the PI3-kinase-Akt pathway, anesthetized, intubated male swine (40 –50lbs) were studied. Five animals had no intervention (BL) and 5 received 1 hr pGz preconditioning (pGz) followed by Western Blot of myocardial tissue. Additional animals (10 per group) received 1 hr pGz (PRE-pGz) or no treatment (CPR-CONT). In the latter groups VF was electrically induced and unsupported for 8 min followed by continuous manual chest compression and defibrillation for 10 min or until return of spontaneous circulation (ROSC). PRE-pGz animals showed less hemodynamically significant arrhythmias after ROSC than CPR-CONT (35 vs 7; p<0.05) and less myocardial stunning. eNOS and phosphorylated-eNOS (p-eNOS) significantly increased after pGz and after CPR but were significantly higher in pGz preconditioned animals along with increased phosphorylated Akt (p-Akt). The graph below shows % changes relative to BL (M±SD). *p < 0.01 PRE-pGz vs CPR-CONT. Conclusion: pGz applied prior to ischemia reperfusion injury increases eNOS and p-eNOS expression and increased p-Akt. Thus, pGz preconditioning protects myocardium during I-R in part by activating eNOS through p-Akt

Abstract 111: Age-Dependent Trends in Survival After Adult In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sebastian Wiberg ◽  
Mathias J Holmberg ◽  
Michael Donnino ◽  
Jesper Kjaergaard ◽  
Christian Hassager ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Age Groups ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Absolute Increase ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims or extends to older patients as well. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. Methods: This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between January 2000 and December 2016. The primary outcome was survival to hospital discharge, while secondary outcomes included rates of return of spontaneous circulation (ROSC) and neurological outcome at discharge. Patients were stratified into five age groups: < 50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. Analyses of interaction were included to assess differences in survival trends between age groups. Results: A total of 234,767 IHCA patients were included for the analyses. The absolute increase in survival per calendar year was 0.8% (95%CI 0.7 - 1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95%CI 0.4 - 0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients older than 80 years. Further, a significant increase in both rates of ROSC and survival with a good neurological outcome was seen for all age groups. In both unadjusted and adjusted analyses of survival, we observed a significant interaction between calendar year and age group ( p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. Conclusions: For patients with IHCA, survival to discharge, ROSC, and survival to discharge with a good neurological outcome have improved significantly from 2000 to 2016 for all age groups.

Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristian Kragholm ◽  
Monique Anderson ◽  
Carolina Malta Hansen ◽  
Phillip J. Schulte ◽  
Michael C. Kurz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Significant Survival ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

Abstract 296: Adult Swine Model of Ventricular Fibrillation Arrest for Resuscitation with Perfluorocarbon Emulsions

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Travis W Murphy ◽  
Jiepei Zhu ◽  
Travis Parsons ◽  
Bruce D Spiess ◽  
Torben K Becker
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Minimally Invasive ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Circulatory Arrest ◽  
Spontaneous Circulation ◽  
Blood Levels ◽  
Swine Model ◽  
Initial Attempt

Background: The purpose of this study was to develop a model of ventricular fibrillation arrest with reliable outcomes and minimally invasive methods to study the use of perfluorocarbon emulsions (PFC) as agents to prevent ischemia-reperfusion injury after cardiac arrest as quantified by known biomarkers. Methods: Female Yorkshire swine underwent anesthesia and minimally invasive instrumentation for monitoring under ultrasound. Cardiac arrest was induced with spinal needle insertion at the apex and right parasternal space. Ventricular fibrillation was reliably obtained in all animals on initial attempts. A three-minute circulatory arrest state was observed. Administration of PFC was concurrent with resuscitation including closed chest compressions, epinephrine, amiodarone, and defibrillation at 1J/kg. Primary endpoint was induction of cardiac arrest and tolerance of PFC with return of spontaneous circulation. Blood levels of glial fibrillary acidic protein (GFAP) and ubiquitin C-Terminal Hydrolase-L1 (UCLH1) were secondary end points for three animals. Results: Six of six animals were induced into ventricular fibrillation on initial attempt and two of three survival experiments were able to obtain spontaneous circulation. PFC with pretreatment was tolerated well and no signs of increased pulmonary pressures. GFAP, UCHL1 were significantly lower in intervention animals compared to controls. Conclusions: The results obtained from this preliminary study and technical refinements via additional donated animals have allowed us to make modifications in the choice of PFC, vascular access, and anticoagulation plan. This model provides a consistent method for inducing ventricular fibrillation with minimally invasive techniques. The PFC tested was well tolerated. More robust evaluation of PFC as resuscitative agents is needed with appropriately powered studies.

scholarly journals Comparing anesthesia with isoflurane and fentanyl/fluanisone/midazolam in a rat model of cardiac arrest

2017 ◽  
Vol 123 (4) ◽  
pp. 867-875 ◽  
Author(s):  
Niels Secher ◽  
Christian Lind Malte ◽  
Else Tønnesen ◽  
Leif Østergaard ◽  
Asger Granfeldt
Keyword(s):  
Cardiac Arrest ◽  
Reperfusion Injury ◽  
Perfusion Pressure ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Return Of Spontaneous Circulation ◽  
Arterial Blood

Only one in ten patients survives cardiac arrest (CA), underscoring the need to improve CA management. Isoflurane has shown cardio- and neuroprotective effects in animal models of ischemia-reperfusion injury. Therefore, the beneficial effect of isoflurane should be tested in an experimental CA model. We hypothesize that isoflurane anesthesia improves short-term outcome following resuscitation from CA compared with a subcutaneous fentanyl/fluanisone/midazolam anesthesia. Male Sprague-Dawley rats were randomized to anesthesia with isoflurane ( n = 11) or fentanyl/fluanisone/midazolam ( n = 11). After 10 min of asphyxial CA, animals were resuscitated by mechanical chest compressions, ventilations, and epinephrine and observed for 30 min. Hemodynamics, including coronary perfusion pressure, systemic O2 consumption, and arterial blood gases, were recorded throughout the study. Plasma samples for endothelin-1 and cathecolamines were drawn before and after CA. Compared with fentanyl/fluanisone/midazolam anesthesia, isoflurane resulted in a shorter time to return of spontaneous circulation (ROSC), less use of epinephrine, increased coronary perfusion pressure during cardiopulmonary resusitation, higher mean arterial pressure post-ROSC, increased plasma levels of endothelin-1, and decreased levels of epinephrine. The choice of anesthesia did not affect ROSC rate or systemic O2 consumption. Isoflurane reduces time to ROSC, increases coronary perfusion pressure, and improves hemodynamic function, all of which are important parameters in CA models. NEW & NOTEWORTHY The preconditioning effect of volatile anesthetics in studies of ischemia-reperfusion injury has been demonstrated in several studies. This study shows the importance of anesthesia in experimental cardiac arrest studies as isoflurane raised coronary perfusion pressure during resuscitation, reduced time to return of spontaneous circulation, and increased arterial blood pressure in the post-cardiac arrest period. These effects on key outcome measures in cardiac arrest research are important in the interpretation of results from animal studies.

scholarly journals Mild Hypothermia Inhibits Systemic and Cerebral Complement Activation in a Swine Model of Cardiac Arrest

2015 ◽  
Vol 35 (8) ◽  
pp. 1289-1295 ◽  
Author(s):  
Ping Gong ◽  
g Zhao ◽  
Rong Hua ◽  
Mingyue Zhang ◽  
Ziren Tang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Complement Activation ◽  
Ischemia Reperfusion Injury ◽  
Mild Hypothermia ◽  
Ischemia Reperfusion ◽  
Spontaneous Circulation ◽  
Enzyme Linked Immunosorbent Assay ◽  
Swine Model ◽  
Factor Α ◽  
Necrosis Factor

Complement activation has been implicated in ischemia/reperfusion injury. This study aimed to determine whether mild hypothermia (HT) inhibits systemic and cerebral complement activation after resuscitation from cardiac arrest. Sixteen minipigs resuscitated from 8 minutes of untreated ventricular fibrillation were randomized into two groups: HT group ( n = 8), treated with HT (33 °C) for 12 hours; and normothermia group ( n = 8), treated similarly as HT group except for cooling. Blood samples were collected at baseline and 0.5, 6, 12, and 24 hours after return of spontaneous circulation (ROSC). The brain cortex was harvested 24 hours after ROSC. Complement and pro-inflammatory markers were detected using enzyme-linked immunosorbent assay. Neurologic deficit scores were evaluated 24 hours after ROSC. C1q, Bb, mannose-binding lectin (MBL), C3b, C3a, C5a, interleukin-6, and tumor necrosis factor- α levels were significantly increased under normothermia within 24 hours after ROSC. However, these increases were significantly reduced by HT. Hypothermia decreased brain C1q, MBL, C3b, and C5a contents 24 hours after ROSC. Hypothermic pigs had a better neurologic outcome than normothermic pigs. In conclusion, complement is activated through classic, alternative, and MBL pathways after ROSC. Hypothermia inhibits systemic and cerebral complement activation, which may provide an additional mechanism of cerebral protection.

Abstract 18150: Ventricular Arrhythmia During Post Cardiac Arrest Care: Prognostic Importance and Influence of Pre-hospital Defibrillation - A TTM Substudy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jakob H Thomsen ◽  
Jesper Kjærgaard ◽  
Niklas Nielsen ◽  
David Erlinge ◽  
Michael Wanscher ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Temperature Management ◽  
Patients At Risk ◽  
Initial Rhythm ◽  
Life Threatening ◽  
Bystander Cpr ◽  
Prognostic Importance

Background: Ventricular arrhythmias (VA) are life threatening, even in patients admitted to an intensive care unit following out-of-hospital cardiac arrest (OHCA). Post cardiac arrest care includes hemodynamic stabilization and targeted temperature management (TTM) and while most patients are stabilized, VA may occur. We assessed the prognosis of OHCA patients with in-hospital VA and whether the number of pre-hospital defibrillations was predictive of in-hospital arrhythmic events. Method: We studied 934 (99%) comatose OHCA survivors from the TTM-trial (year: 2010-13) with available data on VA during the first 2 days of post cardiac arrest care and the number of pre-hospital defibrillation used to achieve return of spontaneous circulation (ROSC). The TTM trial showed no benefit of TTM at 33°C over 36°C in terms of mortality and neurological outcome. Results: The prevalence of VA was 16% and did not differ between the TTM groups (33°C= 82 (17%) vs. 36°C= 67 (15%), p=0.23). Patients with VA had similar 180-day survival rates (VA= 52% vs. no-VA= 53%, plog-rank= 0.63, Figure) and odds of unfavorable neurological outcome (OR=1.04 (0.73-1.48, p=0.83), compared to patients without VA. The number of pre-hospital defibrillations ranged from 0 to >20 and a twofold increase was associated with significantly higher odds of in-hospital VA, both combined (OR= 1.39 (1.22-1.59, p<0.0001), and separately as risk of ventricular tachycardia (OR= 1.39 (1.20-1.60, p<0.0001) and fibrillation (OR= 1.54 (1.23-1.93 p<0.001). This remained significant when adjusting for STEMI, initial rhythm, age, sex, bystander CPR, time to ROSC and admission lactate. Conclusion: Risk of VA is directly related to the number of pre-hospital defibrillations, which may be of value in predicting patients at risk of arrhythmia. VA occurring during post cardiac arrest care has no significant impact on prognosis, which supports continued active treatment in patients with recurrent VA after OHCA.

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