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

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.

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

Circulation ◽

10.1161/circ.140.suppl_2.111 ◽

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.

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Abstract 186: Sex Differences in Outcomes for Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.186 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Pavitra Kotini-Shah ◽

Oksana Pugach ◽

Ruizhe Chen ◽

Marina Del Rios ◽

Kimberly Vellano ◽

...

Keyword(s):

United States ◽

Cardiac Arrest ◽

Sex Differences ◽

Coronary Angiography ◽

Neurological Outcome ◽

The United States ◽

Neurological Outcomes ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.

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Abstract 132: Neurological Favorable Outcome Associated With Number of Prehospital Defibrillation Attempts in Out-of-Hospital Cardiac Arrest Without Return of Spontaneous Circulation on Scene

Circulation ◽

10.1161/circ.138.suppl_2.132 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Seulki Choi ◽

Tae Han Kim ◽

Ki Jeong Hong ◽

Sung Wook Song ◽

Joo Jeong ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Life Support ◽

Discharge Rate ◽

Spontaneous Circulation ◽

Successful Resuscitation ◽

Return Of Spontaneous Circulation ◽

Hospital Transport ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Background: The early and timely defibrillation in shockable rhythm of out-of-hospital cardiac arrest (OHCA) by prehospital EMS providers is crucial for successful resuscitation. In emergency medical service (EMS) system, where advanced cardiac life support could not be fully provided before hospital transport, optimal range of prehospital defibrillation attempts is debatable. We evaluated association between number of prehospital defibrillation attempts and survival outcomes in OHCA patients who were unresponsive to field resuscitation and defibrillations. Methods: This is a retrospective observational study using nationwide OHCA registry of Korea from 2013 to 2016. Adult EMS treated OHCA with presumed cardiac origin with shockable initial ECG rhythm were enrolled. Final analysis was performed in patients who did not achieve return of spontaneous circulation (ROSC) on scene before hospital transport. We categorized number of prehospital defibrillation attempt into 3 groups: ≤3 attempts, 4-5 attempts and ≥6 attempts. Primary outcome was favorable neurological outcome at hospital discharge. Multivariable logistic regression modeling was used to evaluate association between neurological outcome and defibrillation attempts. Result: Total 6,679 patients were enrolled for final analyzed. Among total ≤3 defibrillations were attempted in 5015 patients (75.1%), 1050 patients (15.7%) for 4-5 attempts, 614 patient. (9.2%) for ≥6 attempts. Although survival to discharge rate was highest in group with ≤3 defibrillation attempts (8.1% vs. 7.0% vs. 2.9%, p<0.01), survival rate with favorable neurological outcome was highest in group with 4-5 defibrillation attempts (3.0% vs. 4.5% vs. 2.1%, p=0.02). As 4-5 attempts group reference, adjusted odds ratio for favorable neurological outcome of ≤3 attempts was 0.66 (95% CI 0.46 - 0.94) and of ≥6 attempts was 0.47 (95% CI 0.25 - 0.89). Conclusion: For patients with shockable initial cardiac rhythm who were unresponsive to filed defibrillation and resuscitation, moderate amount of defibrillation attempt was associated with favorable neurological outcome compared to fewer defibrillation attempts and prolonged number of defibrillation attempts on scene.

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Abstract 152: Effect of the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm

Circulation ◽

10.1161/circ.138.suppl_2.152 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Tadashi Ashida ◽

Tsukasa Yagi ◽

Ken Nagao ◽

Shigemasa Tani ◽

Eizo Tachibana ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Multivariable Analysis ◽

Population Based ◽

Spontaneous Circulation ◽

Adult Patients ◽

Shockable Rhythm ◽

Class Iib ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Background: The 2010 guidelines have stressed that systematic post-cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological outcome. However, the 2010 guidelines showed that induced therapeutic hypothermia may be considered for comatose adult patients with ROSC after out-of-hospital cardiac arrest (OHCA) with an initial rhythm of non-shockable (Class IIb). It is unknown whether the post-cardiac arrest care for patients with non-shockable cardiac arrest contributed to favorable neurological outcome. The aim of the present study was to clarify the effects of the 2010 guidelines in patients with ROSC after cardiac arrest due to non-shockable rhythm, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA. Methods: From the data of this registry between 2005 and 2015, we included adult patients with ROSC after out-of-hospital non-shockable cardiac arrest due to cardiac etiology. Study patients were divided into three groups based on the different CPR guidelines; the era of the 2000 guidelines (2000G), the era of the 2005 guidelines (2005G), and the era of the 2010 guidelines (2010G). The endpoint was favorable neurological outcome at 30 days after OHCA. Results: The 31,204 patients who met the inclusion criteria comprised 25,045 with ROSC before arrival at the hospital and 6,259 with ROSC after hospital arrival without prehospital ROSC. Figure showed favorable neurological outcome at 30 days in the three groups. Moreover, multivariable analysis showed that the 2010 guidelines were an independent predictor of favorable neurological outcome at 30 days after OHCA, respectively (Figure). Conclusion: In the patients with ROSC after out-of-hospital non-shockable cardiac arrest, the 2010 guidelines were superior to the 2005 guidelines and the 2000 guidelines, in terms of neurological benefits.

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Abstract 342: The Relationship Between Time Interval From Collapse to Return of Spontaneous Circulation After Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival

Circulation ◽

10.1161/circ.138.suppl_2.342 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Ken Nagao ◽

Yoshio Tahara ◽

Hiroshi Nonogi ◽

Naohiro Yonemoto ◽

David F Gaieski ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

Adult Patients ◽

Time Interval ◽

Return Of Spontaneous Circulation ◽

Favorable Neurological Outcome ◽

The Relationship ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Background: Early cardiopulmonary resuscitation (CPR) and early defibrillation are critical to survival from out-of-hospital cardiac arrest (OHCA). However, few studies have investigated the relationship between time interval from collapse to return of spontaneous circulation (ROSC) and neurologically intact survival. Methods: From the All-Japan OHCA Utstein Registry between 2005 and 2015, we enrolled adult patients achieving prehospital ROSC after witnessed OHCA, inclusive of arrest after emergency medical service responder arrival. The study patients were divided into two groups according to initial cardiac arrest rhythm (shockable versus non-shockable). The collapse-to-ROSC interval was calculated as the time interval from collapse to first achievement of prehospital ROSC. The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: A total of 69,208 adult patients achieving prehospital ROSC after witnessed OHCA were enrolled; 23,017(33.3%) the shockable arrest group and 46,191 (66.7%) the non-shockable arrest group. The shockable arrest group compared with the non-shockable arrest group had significantly shorter collapse-to-ROSC interval (16±10 min vs. 20±13 min, P<0.001) and significantly higher frequency of the favorable neurological outcome (54.9% vs. 15.3%, P<0.001). Frequencies of the favorable neurological outcome after shockable OHCA decreased to 1.2% to 1.5% with every minute that the collapse-to-ROSC interval was delayed (78% at 1 minute of collapse, 68% at 10 minutes, 44% at 20 minutes, 34% at 30 minutes, 16% at 40 minutes, 4% at 50 minutes and 0% at 60 minutes, respectively, P<0.001), and those after non-shockable OHCA decreased to 0.8% to 1.8% with every minute that the collapse-to-ROSC interval was delayed (40% at 1 minute of collapse, 26% at 10 minutes, 11% at 20 minutes, 5% at 30 minutes, 2% at 40 minutes, 0% at 50 minutes and 0% at 60 minutes, respectively, P<0.001). Conclusions: Termination of the collapse-to-ROSC interval to achieve neurologically intact survival after witnessed OHCA was 50 minutes or longer irrespective of initial cardiac arrest rhythm (shockable versus non-shockable), although the neurologically intact survival rate was difference between the two groups.

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Abstract 475: Association Between Bystander Delay in Activating the Emergency Response System and Outcomes Following Out-Of-Hospital Cardiac Arrest: All-Japan National Utstein Registry

Circulation ◽

10.1161/circ.140.suppl_2.475 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Tomoyoshi Tamura ◽

Tomohisa SEKI ◽

Masaru Suzuki ◽

Junichi Sasaki

Keyword(s):

Cardiac Arrest ◽

Emergency Response ◽

Neurological Outcome ◽

Epinephrine Administration ◽

Emergency Response System ◽

Response System ◽

Chain Of Survival ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: An emphasis on the chain of survival has contributed to improved outcomes of out-of-hospital cardiac arrest (OHCA). Although immediate recognition of cardiac arrest (CA) and activation of the emergency response system are the first links in the chain of survival, their impact on outcomes is unclear. Hypothesis: Delayed time from collapse to activation of the emergency response system (bystander delay) is associated with an unfavorable neurological outcome after adult OHCA. Methods: Data from the prospective, nationwide, population-based All-Japan Utstein Registry of the Fire and Disaster Management Agency between January 1, 2012 and December 31, 2016 were analyzed. Of the 625,916 eligible cases, 164,256 adult, non-traumatic, witnessed OHCA including bystander delay times (age, 79 [IQR, 67-86] years; 60% male) were studied. The primary outcome measure was favorable neurological outcome 1 month after an OHCA, defined as a score of 1 or 2 on the Cerebral Performance Category Scale. Results: The median bystander delay time of 2.0 [1.0-4.0] min was shorter among patients who achieved a favorable outcome as compared to 3.0 [1.0-6.0] min (P < 0.001) for patients with an unfavorable outcome. In multivariable logistic regression analyses, bystander delay had an OR for favorable neurological outcome of 0.94 [95% CI, 0.93-0.97] after adjusting for age, sex, etiology of arrest, first documented rhythm, provision of bystander CPR, use of public access automated external defibrillator, epinephrine administration, time intervals of activation of the emergency response system and hospital arrival, and collapse to initiation of CPR, and regional location. Similarly, bystander delay was independently associated with reduced neurologically favorable survival among patients who received bystander CPR within one minute of collapse (adjusted OR, 0.97 [0.97-0.98]). Conclusions: Bystander delay was independently associated with decreased odds of neurologically favorable survival, even among patients for whom bystander CPR was immediately performed.

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The Importance of the Time that Elapses Before Spontaneous Circulation is Established Following an Out-of-Hospital Cardiac Arrest

Open Medicine Journal ◽

10.2174/1874220301805010033 ◽

2018 ◽

Vol 5 (1) ◽

pp. 33-38

Author(s):

Atsushi Sakurai ◽

Kosaku Kinoshita ◽

Akira Utagawa ◽

Junko Yamaguchi ◽

Makoto Furukawa ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

Emergency Call ◽

Elapsed Time ◽

Outcome Group ◽

Favorable Neurological Outcome ◽

Utstein Style ◽

Hospital Cardiac Arrest

Objective: In order to clarify indications for therapeutic hypothermia, we retrospectively examined patients resuscitated after Out-of-Hospital Cardiac Arrest (OHCA) who recorded an Auditory Brainstem Response (ABR) wave V according to the Utstein-style guidelines. Methods: Patients who recorded an ABR wave V immediately after resuscitation from OHCA were kept at 34 °C for 48 hours. The cohort was divided into two groups: A favorable neurological outcome group (F group: N=12) and an unfavorable neurological outcome group (U group: N=14). Favorable neurological outcome was defined as Pittsburgh Cerebral-Performance Scale (CPC) 1 or 2 and unfavorable as CPC 3-5. Data used to compare the groups included whether CA was witnessed, if a bystander initiated cardiopulmonary resuscitation, presence of cardiac etiology, initial cardiac rhythm and elapsed time from emergency call receipt until Return of Spontaneous Circulation (ROSC). Results: Elapsed time from receipt of the emergency call until ROSC was significantly shorter in the F group than in the U group. ROC curve analysis indicated that the cut-off duration was 28 minutes for a favorable neurological outcome. Conclusion: For OHCA patients with an ABR wave V, elapsed time from receipt of emergency call until ROSC may be an important parameter within the Utstein-style guidelines to determine the usefulness of therapeutic hypothermia.

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Survival and neurological recovery after out-of-hospital cardiac arrest

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.147 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Jarakovic ◽

S Bjelica ◽

M Kovacevic ◽

M Petrovic ◽

S Dimic ◽

...

Keyword(s):

Cardiac Arrest ◽

Neurological Outcome ◽

Cerebral Performance Category ◽

Study Group ◽

St Segment Elevation ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health challenge and although rate of intrahospital survival increased over the last 40 years, it still remains poor (from 8,6% in 1976-1999 to 9,9% in 2000-2019). Different studies report that introduction of mild therapeutic hypothermia (TTM) improves survival and neurological outcome in comatose patients after OHCA. Purpose The aim of this research was to evaluate influence of pre-hospital predictors related to cardiopulmonary resuscitation (CPR), neurological status and ECG changes at admission and early percutaneous coronary intervention (PCI) performed within 24h of admission on intrahospital survival and neurological outcome of OHCA patients. Methods The research was conducted as a retrospective cohort study of data taken from the hospital registry on OHCA from January 2007 until November 2019. The analyzed factors were: bystander CPR, duration of CPR until return of ROSC, initial rhythm, responsiveness upon admission defined as Glasgow Coma Score (GCS)>8, presence of ST segment elevation (STEMI) on electrocardiography (ECG) and early PCI. The favorable neurological outcome was defined as a cerebral performance category scale (CPC)≤2. Results The research included 506 survivors of OHCA. Cardiac arrest was witnessed in 412 (81.4%), bystander CPR was performed in 197 (38.9%), CPR lasted ≤20min in 291 (57.5%), initial rhythm was shockable in 304 (60.1%) of patients. At admission 387 (76.5%) were comatose (GCS < 8) and TTM was introduced in 177 (45.7%) of patients. ECG upon admission showed STEMI in 176 (34.8%) and early PCI was performed in 145 (28.6%) of patients. In-hospital mortality in our study group was 281 (55.5%) and 185 (36.6%) of patients had favorable neurological outcome. Multivariate regression analysis showed that initial shockable rhythm (OR 3.391 [2.310-4.977], p < 0.0005), early PCI (OR 0.368 [0.226-0.599], p < 0.0005), duration of CPR ≤20min (OR 4.249 [2.688-6.718], p < 0.0005) and GCS > 8 (OR 0.194 [0.110-0.343], p < 0.0005) were independent predictors of in-hospital survival. Independent predictors of favorable neurological outcome were: initial shockable rhythm (OR 3.301 [2.002-5.441], p< 0.0005), STEMI on ECG upon admission (OR 0.528 [0.326-0.853], p = 0.009), duration of CPR ≤20min (OR 5.144 [3.090-8.565], p< 0.0005) and GCS > 8 (OR 0.152 [0.088-0.260], p< 0.0005). Introduction of TTM improved both intrahospital survival (54.1% vs. 24.4%; p < 0.0005) and neurological outcome (33.5% vs. 11.6%; p < 0.0005) in patients with initial shockable rhythm. Conclusion In our study group of OHCA patients of any origin, initial shockable rhythm, duration of CPR ≤20min and GCS > 8 at admission influenced both intrahospital survival and favorable neurological outcome. Introduction of TTM significantly improved both survival and neurological outcome in comatose patients with initial shockable rhythm.

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Abstract 124: Chest Compression Pause Duration is Associated with Worse Survival Outcomes Following Pediatric In-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_4.124 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Kasper Glerup Lauridsen ◽

Ryan W Morgan ◽

Robert A Berg ◽

Dana E Niles ◽

Monica E Kleinman ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Neurological Outcome ◽

Pause Duration ◽

Spontaneous Circulation ◽

Survival Outcomes ◽

Lower Odds ◽

Return Of Spontaneous Circulation ◽

Favorable Neurological Outcome ◽

Hospital Cardiac Arrest

Introduction: The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest (IHCA) survival outcomes is unknown. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes. Methods: Cohort study of all index pediatric IHCAs (<18 years of age) ≥1 min in the Pediatric Resuscitation Quality (PediRES-Q) Network from July 2015 through December 2019. We used multivariate logistic regression with mixed effects and robust standard errors to analyze association of 5-sec increments of longest CC pause duration with survival and neurologic outcomes. Favorable neurological outcome was defined as Pediatric Cerebral Performance Category (PCPC) at discharge ≤3 or no change from baseline. Results: We identified 371 index IHCAs: median [Q1,Q3] age 2.6 [0.6,9.4] years, female 46%, shockable rhythm 13%, CPR duration 23 [9,47] min. Median length of the longest pause was 17 [8,27] sec. Each 5 sec increase in longest CC pause duration was associated with 6% lower odds for survival with favorable neurological outcome, even after adjusting for age, defibrillation, intubation, extracorporeal CPR, illness category, hypotension as etiology for arrest, CC depth, and clustering by site (aOR 0.94 [95% CI:0.88-0.99], p=0.04). Analyses controlling for the same factors demonstrated an association of longest pause duration with lower odds for survival to hospital discharge (aOR 0.94 [95% CI: 0.90-0.99, p=0.02) and return of spontaneous circulation (aOR 0.91 [(95% CI: 0.86-0.96], p=0.001). Conclusions: Longest CC pause duration is associated with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation following pediatric IHCA, even when controlling for known confounders and clustering by site. Each 5 sec. increment in longest CC pause duration was associated with 6% lower odds for survival with favorable neurological outcome.

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

Circulation ◽

10.1161/circ.132.suppl_3.18150 ◽

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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