Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ian R Drennan ◽  
Steve Lin ◽  
Kevin E Thorpe ◽  
Jason E Buick ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Injury ◽  
Good Neurologic Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

Background Frequency Patterns in Standard Electroencephalography During Targeted Temperature Management as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors: a retrospective cohort study

2020 ◽  
Author(s):  
Youn-Jung Kim ◽  
Min-jee Kim ◽  
Yong Seo Koo ◽  
Won Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Clinical Features ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Background Frequency ◽  
Prognostic Tool ◽  
Logistic Analysis ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Abstract Background Electroencephalography is a widely used tool for detecting epileptiform and assessing neurological outcomes after cardiac arrest. We investigated the prognostic value of standard electroencephalography during early post-cardiac arrest period and evaluated the performance of electroencephalography findings combined with other clinical features for predicting good outcome. Methods This observational registry-based study was conducted at tertiary care hospital in Korea. Data of all consecutive adult comatose out-of-hospital cardiac arrest survivors who underwent electroencephalography during targeted temperature management between 2010 and 2018 were extracted. Electroencephalography findings, classified according to the American Clinical Neurophysiological Society critical care electroencephalography terminology, and good neurologic outcome-related clinical features were identified via multivariable logistic analysis. Results Good outcomes were observed in 36.5% of 170 patients. Median electroencephalography time was 22.0 hours. Electroencephalography background, voltage and other findings (burst suppression, reactivity to pain stimuli) significantly differed between good and poor outcome groups. Electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 9.8 (95% confidence interval 3.9-24.9) in multivariable logistic analysis. Electroencephalography background frequency enabled identification of a good neurologic outcome (sensitivity, 83.87%; specificity, 75.93%). Combination of other clinical features (age<65 years, initial shockable rhythm, resuscitation duration<20 min) with electroencephalography findings increased predictive performance for good neurologic outcomes (sensitivity, 95.2%; specificity, 100%). ConclusionsBackground frequency patterns of standard electroencephalography during targeted temperature management may play a role as an early prognostic tool in out-of-hospital cardiac arrest patients.

scholarly journals Optimal Time of Collapse to Return of Spontaneous Circulation to Apply Targeted Temperature Management for Cardiac Arrest: A Bayesian Network Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
Jingwei Duan ◽  
Qiangrong Zhai ◽  
Yuanchao Shi ◽  
Hongxia Ge ◽  
Kang Zheng ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Bayesian Network ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Return Of Spontaneous Circulation ◽  
Neurologic Outcomes ◽  
Good Neurologic Outcome

Background: Both the American Heart Association (AHA) and European Resuscitation Council (ERC) have strongly recommended targeted temperature management (TTM) for patients who remain in coma after return of spontaneous circulation (ROSC). However, the role of TTM, especially hypothermia, in cardiac arrest patients after TTM2 trials has become much uncertain.Methods: We searched four online databases (PubMed, Embase, CENTRAL, and Web of Science) and conducted a Bayesian network meta-analysis. Based on the time of collapse to ROSC and whether the patient received TTM or not, we divided this analysis into eight groups (&lt;20 min + TTM, &lt;20 min, 20–39 min + TTM, 20–39 min, 40–59 min + TTM, 40–59 min, ≥60 min + TTM and ≥60 min) to compare their 30-day and at-discharge survival and neurologic outcomes.Results: From an initial search of 3,023 articles, a total of 9,005 patients from 42 trials were eligible and were included in this network meta-analysis. Compared with other groups, patients in the &lt;20 min + TTM group were more likely to have better survival and good neurologic outcomes (probability = 46.1 and 52.5%, respectively). In comparing the same time groups with and without TTM, only the survival and neurologic outcome of the 20–39 min + TTM group was significantly better than that of the 20–39 min group [odds ratio = 1.41, 95% confidence interval (1.04–1.91); OR = 1.46, 95% CI (1.07–2.00) respectively]. Applying TTM with &lt;20 min or more than 40 min of collapse to ROSC did not improve survival or neurologic outcome [ &lt;20 min vs. &lt;20 min + TTM: OR = 1.02, 95% CI (0.61–1.71)/OR = 1.03, 95% CI (0.61–1.75); 40–59 min vs. 40–59 min + TTM: OR = 1.50, 95% CI (0.97–2.32)/OR = 1.40, 95% CI (0.81–2.44); ≧60 min vs. ≧60 min + TTM: OR = 2.09, 95% CI (0.70–6.24)/OR = 4.14, 95% CI (0.91–18.74), respectively]. Both survival and good neurologic outcome were closely related to the time from collapse to ROSC.Conclusion: Survival and good neurologic outcome are closely associated with the time of collapse to ROSC. These findings supported that 20–40 min of collapse to ROSC should be a more suitable indication for TTM for cardiac arrest patients. Moreover, the future trials should pay more attention to these patients who suffer from moderate injury.Systematic Review Registration: [https://inplasy.com/?s=202180027], identifier [INPLASY202180027]

Abstract 407: Utility of Abnormal Head Computed Tomography in Predicting Outcome in Out of Hospital Cardiac Arrest Victims Resuscitated and Subsequently Placed on Targeted Temperature Management

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Michael Bernett ◽  
Robert A Swor
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Survival Analysis ◽  
Interrater Reliability ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Radiology Reports ◽  
Head Computed Tomography ◽  
Hospital Cardiac Arrest

Introduction: Head computed tomography (HCT) is often performed to assess for hypoxic-ischemic brain injury in resuscitated out of hospital cardiac arrest (OHCA) patients. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome post OHCA. Methods: We included subjects from a prospectively collected cardiac arrest database of OHCA adult patients who received targeted temperature management (TTM) at two academic suburban hospitals from 2009-Sept-2018. Cases were included if a HCT was performed in the emergency department (ED). Patient demographics and cardiac arrest variables were collected. HCT results were abstracted by study authors from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, stroke). Outcomes were survival to discharge or cerebral performance scores (CPC) at discharge of three or four (poor neurologic outcome). Descriptive statistics, univariate, multivariate, survival, and interrater reliability analysis were performed. Results: During the study period, there were 425 OHCA, 277 cases had ED HCTs performed; 254 cases were included in the final survival analysis. Patients were predominately male, 189 (65.0%), average age 60.9 years, average BMI of 30.5. Of all cases, 44 (15.9%) showed CE on CT. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (OR: 9.23; 95% CI 1.73, 49.2), and 9.1-fold greater odds of death (OR: 9.09: 95% CI 2.4 33.9). In adjusted analysis, CE was associated with 14.9-fold greater odds of poor CPC outcome (AOR: 14.9, 95% CI, 2.49, 88.4), and 13.7-fold greater odds of death (AOR: 13.7, 95% CI, 3.26, 57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (HR: 3.56: 95% CI 2.34, 5.41). Interrater reliability demonstrated excellent agreement between reviewers for CE on HCT (κ = 0.86). Conclusion: The results identify that abnormal HCTs early in the post-arrest period in OHCA patients are associated with poor rates of survival and neurologic outcome. Prospective work is needed to confirm whether selection bias or other variables confound this association.

scholarly journals How many prehospital defibrillation attempts should be performed in out-of-hospital cardiac arrest patients with shockable rhythm?

2020 ◽  
Author(s):  
Byuk Sung Ko ◽  
Youn-Jung Kim ◽  
Kap Su Han ◽  
You Hwan Jo ◽  
Jonghwan Shin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Odds Ratio ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Secondary Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Shockable Rhythm ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Abstract Background: Early defibrillation is vital to improve outcomes after out-of-hospital cardiac arrest (OHCA) with shockable rhythm. Currently, there is no agreed consensus on the number of defibrillation attempts before transfer to a hospital. This study aimed to evaluate the correlation between the number of defibrillations on the prehospital return of spontaneous circulation (ROSC).Methods: A multicenter, prospective, observational registry-based study was conducted for OHCA in patients with presumed cardiac etiology that underwent prehospital defibrillation between October 2015 and June 2017. The primary outcome was prehospital ROSC, and the secondary outcome was a good neurologic outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Results: Among 2,155 OHCA patients’ data, 178 patients with missing data were excluded, a total of 1,983 OHCA patients who received prehospital defibrillation were included. The median age was 61 years and prehospital ROSC was observed in 738 patients (37.2%). The median time from arrest to first defibrillation was 10 (interquartile range: 7-15) minutes. The cumulative ROSC rates and good neurologic outcome from the initial defibrillation to the sixth defibrillation were 43%, 68%, 81%, 90%, 95%, 98% and 42%, 66%, 81%, 90%, 95%, 98%, respectively. After clinical characteristics adjustment and time to defibrillation, the number of defibrillations were independently associated with ROSC (odds ratio 0.81 95% CI 0.76-0.86) and good neurologic outcome (odds ratio 0.86 95% CI 0.80-0.91). Moreover, subgroup analysis results with patients that underwent the initial defibrillation within 10 minutes from arrest were consistent (95% up to five times).Conclusion: More than 95% of prehospital ROSC was achieved within five times of defibrillation in OHCA patients. This result provides a basis for the ideal number of defibrillation attempts before transfer to hospital with the possibility of extracorporeal cardiopulmonary resuscitation in these refractory ventricular fibrillation patients.

Abstract 333: A Prospective Study of the Incidence of Intracranial Hemorrhage in Survivors of Out of Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jonathan Gelber ◽  
Martha E Montgomery ◽  
Amandeep Singh
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Prospective Study ◽  
Intracranial Hemorrhage ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
The Us ◽  
Good Neurologic Outcome ◽  
A Prospective Study ◽  
Hospital Cardiac Arrest

Introduction: Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence. A single Japanese prospective study found a high incidence of ICH in survivors of OHCA (18.3% incidence), but that data is not generalizable to the US, which has a far lower overall rate of ICH. Aim: This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC). Methods: We prospectively analyzed all consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period from 2018-2020. A standardized order set, including non-contrast head computed-tomography (NCH-CT), was recommended as part of the initial management for all patients with ROSC after OHCA. Patient and cardiac arrest variables were recorded, as were NCH-CT findings. Results: During the study period, 194 patients presents to the emergency department with OHCA, and 95 patients achieved ROSC and survived to hospital admission. A NCH-CT was obtained in 85/95 patients (89.5%). Twenty-four of 85 patients (28.2%) survived to hospital discharge. Three of 85 patients with NCH-CT had ICH (3.5%). Survival with good neurologic outcome was seen in 14/82 (17.1%) patients without ICH and in 0/3 patients with ICH. Patients with ICH were significantly older than patients without ICH (86.7 years versus 64.4 years, p=0.01). Conclusions: In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission. The incidence of ICH in survivors of OHCA was 3.5%, lower than previously reported retrospective data in the US, and much lower than reported in a prospective Japanese study. No patients with ICH survived with good neurologic outcome.

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