Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

Download Full-text

Abstract 164: Comparison of Tracheal Intubation vs. Supraglottic Airway Following Pediatric Out of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.164 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Maryam Y Naim ◽

Heather Griffis ◽

Robert A Berg ◽

Richard N Bradley ◽

Matthew L Hansen ◽

...

Keyword(s):

Cardiac Arrest ◽

Tracheal Intubation ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Cerebral Performance Category ◽

Supraglottic Airway ◽

Secondary Outcome ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: There are few data comparing Tracheal Intubation (TI) and SupraGlottic Airway (SGA) following pediatric out of hospital cardiac arrest (OHCA). Hypothesis: TI is associated with improved outcomes compared to SGA following pediatric OHCA. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by Emergency Medical Services (EMS). To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and initial rhythm. Primary outcome was neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Secondary outcome was survival to hospital discharge. Results: Of 2653 cardiac arrests evaluated, 2178 (82.1%) had TI and 475 (17.9%) had SGA placed during OHCA. 835 (31.2%) arrests were resuscitated by agencies used bag valve mask (BVM) and TI and 1818 (68.0%) arrests had agencies that used all 3 airway types (BVM/TI/SGA). Overall, unadjusted favorable neurological survival was 5.7% for TI and 5.3% for SGA, p=0.67 and survival to hospital discharge was 7.9% for TI and 7.5% for SGA, p=0.73. In multivariable analysis (adjusting for age, sex, race/ethnicity, bystander witness, bystander CPR, initial rhythm, AED use, year of arrest, and agency category), SGA was associated with lower neurologically favorable survival compared to TI (adjusted proportion 3.7% vs. 6.3%, OR 0.49, p=0.01), and lower survival to hospital discharge (5.5% vs. 8.5%, OR 0.57, 95% CI 0.36, 0.89). These results were robust on tests for unmeasured confounding and covariate balance; propensity analysis neurologically favorable survival 4.4% vs.7.6% (OR 0.54, 95% CI 0.30, 0.96), survival to hospital discharge 6.6% vs.10.5% (OR 0.58, 95% CI 0.35, 0.95); and entropy balance neurologically favorable survival 5.0 % vs. 9.7% for ETI (OR 0.44, 95% CI 0.27, 0.72), survival to hospital discharge 7.3% vs.12.5% (OR 0.51, 95% CI 0.34, 0.78). Conclusion: In pediatric OHCA, TI, compared with SGA advanced airway management is associated with improved neurologically favorable survival and survival to hospital discharge.

Download Full-text

Abstract 120: Outcomes of Out-of-Hospital Cardiac Arrest in Children

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.120 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Natalie Jayaram ◽

Bryan McNally ◽

Fengming Tang ◽

Paul S Chan

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Temporal Trends ◽

Pulseless Electrical Activity ◽

Patient Characteristics ◽

National Registry ◽

Older Children ◽

Shockable Rhythm ◽

Study Population ◽

Hospital Cardiac Arrest

Background: As pediatric out-of-hospital cardiac arrest (OHCA) occurs infrequently, little is known about survival outcomes in children. We examined whether OHCA survival in children differed by patients’ age, sex, and race, as well as recent survival trends. Methods: Within the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective U.S. OHCA registry encompassing 64 million residents, we identified patients less than 18 years of age with an OHCA from October, 2005 to December, 2012. We examined whether survival differed by patients’ age (≤1 year, 1-8 years, >8 years), sex, race, and initial cardiac arrest rhythm, using modified Poisson regression, adjusted for patient characteristics. Similarly, we examined trends in survival, with years 2005-7 as the reference. Results: A total of 1,412 patients with an OHCA were identified, of which 67 (4.7%) were infants, 918 (65.0%) were younger children, and 427 (30.2%) older children. Sixty percent of the study population was male and 33.4% were black. The vast majority of arrests involved a non-shockable rhythm, with only 9.2% of patients having a first documented rhythm of ventricular tachycardia (VT) or ventricular fibrillation (VF). Overall, 103 (7.3%) patients survived to hospital discharge. Of those with non-shockable rhythms (asystole, pulseless electrical activity, and unknown, non-shockable rhythms), 4.4% survived to discharge compared with a survival of 36.2% in those with VT or VF (P<0.001). After adjustment for patient characteristics, children 1-8 years of age were less likely to survive to hospital discharge compared with children >8 years of age (rate ratio [RR]: 0.52; 95% confidence interval [CI]: 0.34, 0.82). In addition, OHCAs due to VT or VF were associated with improved survival (RR 6.67; 95% CI 4.35, 10.23). In contrast, there were no differences in survival by sex or race. Additionally, no temporal trends in survival were observed (p=0.47). Conclusion: In a large, national registry of pediatric OHCA, we found no disparities in survival by patients’ sex, race, or year of arrest, although survival was lower in young children and those with non-shockable cardiac arrest rhythms.

Download Full-text

156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.6 ◽

2020 ◽

Vol 37 (12) ◽

pp. 825.1-825

Author(s):

Ed Barnard ◽

Daniel Sandbach ◽

Tracy Nicholls ◽

Alastair Wilson ◽

Ari Ercole

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Hospital Admission ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Discharge Data ◽

Successful Resuscitation ◽

Bystander Cpr ◽

Number Percentage ◽

Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

Download Full-text

Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.118.suppl_18.s_1462-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Tae Yun Kim ◽

Sun Woo Lee ◽

Kyuseok Kim ◽

Joong Eui Rhee ◽

Sung Koo Jung

Keyword(s):

Cardiac Arrest ◽

Spontaneous Circulation ◽

National Registry ◽

Controlled Clinical Trial ◽

Emergency Medical Service System ◽

Short Term ◽

Combined Administration ◽

Before And After ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

Download Full-text

Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽

10.1161/circ.130.suppl_2.219 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Markus Keferböck ◽

Philip Datler ◽

Mario Krammel ◽

Elisabeth Lobmeyer ◽

Alexander Nürnberger ◽

...

Keyword(s):

Cardiac Arrest ◽

Outcome Measures ◽

Primary Outcome ◽

Sudden Cardiac Arrest ◽

Cerebral Performance Category ◽

Medical Personnel ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

Download Full-text

Abstract 9086: Sex Differences in the Association Between Bystander CPR and Survival for Patients With Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.9086 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Kiok Ahn ◽

Bryan McNally ◽

Paul Chan

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Significant Interaction ◽

National Registry ◽

Republic Of Korea ◽

Secondary Outcome ◽

Multivariable Logistic Regression ◽

Bystander Cpr ◽

The Republic ◽

Hospital Cardiac Arrest

Background: Bystander cardiopulmonary resuscitation (CPR) is associated with a better survival outcome in patients with out-of-hospital cardiac arrest (OHCA). However, there may be cultural barriers in performing high-quality bystander CPR in women in some non-Western countries and the effect of bystander CPR on survival outcomes may differ by patients’ sex. Methods: Using data between 2012-2018 from a national OHCA registry from the Republic of Korea, we identified adult patients with OHCA of presumed cardiac etiology. The main exposures were bystander CPR and patients’ sex. The primary outcome was survival discharge and the secondary outcome was favorable neurological survival. Multivariable logistic regression evaluated the association between bystander CPR and survival, adjusted for patients’ age, sex, socio-economic status, year of arrest, witnessed arrest status, initial OHCA rhythm, location of arrest, urbanization level of arrest location, and type of bystander. The interaction between bystander CPR and sex was explicitly evaluated in the models. Results: Of 101,505 patients with OHCA in the cohort, 34,124 (33.6 %) were women and 67,381 (64.4 %) were men. Bystander CPR was performed on 18,481 (54.2%) women and 35,904 (53.3%) men (p=0.07). Unadjusted rates of survival discharge were 4.5% in women and 9.5 % in men (p<0.001), and rates of favorable neurological survival were 2.5% in women and 6.4% in men (p<0.001). In multivariable logistic regression models, there was a significant interaction (p=0.005) between bystander CPR and sex for survival to discharge, with an adjusted OR for bystander CPR of 1.16 (95% CI: 1.08-1.23) in men and 0.91 (95% CI: 0.80-1.02) in women. For favorable neurological survival, there was also a significant interaction (p=0.01) between sex and bystander CPR, with an adjusted OR for bystander CPR of 1.47 (95% CI: 1.36-1.60) in men and 1.16 (95% CI: 0.98- 1.37) in women. Conclusions: In a national registry of OHCA from the Republic of Korea, men who received bystander CPR were more likely to survive whereas women who received bystander CPR were not.

Download Full-text

Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.44 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Lars W Andersen ◽

Katherine Berg ◽

Brian Z Saindon ◽

Joseph M Massaro ◽

Tia T Raymond ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

National Registry ◽

Epinephrine Administration ◽

Negatively Associated ◽

Logistic Regression Models ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age < 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97], per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.

Download Full-text

Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19005077 ◽

2019 ◽

Vol 35 (1) ◽

pp. 17-23

Author(s):

Julian G. Mapp ◽

Anthony M. Darrington ◽

Stephen A. Harper ◽

Chetan U. Kharod ◽

David A. Miramontes ◽

...

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Hospital Discharge ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

San Antonio ◽

Cerebral Performance Category ◽

Published Data ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

AbstractIntroduction:To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge.Methods:This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC).Results:Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71–1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70–4.11).Conclusion:This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.

Download Full-text

QRS complex characteristics and patient outcomes in out-of-hospital pulseless electrical activity cardiac arrest

Emergency Medicine Journal ◽

10.1136/emermed-2020-209623 ◽

2020 ◽

Vol 38 (1) ◽

pp. 53-58

Author(s):

Jung Ho Kim ◽

Hyun Wook Ryoo ◽

Jong-yeon Kim ◽

Jae Yun Ahn ◽

Sungbae Moon ◽

...

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Hospital Discharge ◽

Neurological Outcome ◽

Prospective Observational Study ◽

Pulseless Electrical Activity ◽

Secondary Outcome ◽

Qrs Complex ◽

The Relationship ◽

Hospital Cardiac Arrest

BackgroundPulseless electrical activity (PEA) is increasingly observed in out-of-hospital cardiac arrest (OHCA), but outcomes are still poor. We aimed to assess the relationship between QRS characteristics and outcomes of patients with OHCA with initial PEA (OHCA-P).MethodsThis prospective observational study included patients aged at least 18 years who developed OHCA-P between 1 January 2016 and 31 December 2018, and were enrolled in the Daegu Emergency Medical Services registry, South Korea. We performed multivariable logistic regression analyses to identify the associations between QRS characteristics and OHCA-P outcomes, in which QRS complexes were considered separately (model 1) and simultaneously (model 2). The primary outcome was survival to hospital discharge and the secondary outcome was a favourable neurological outcome.ResultsOf the 3659 patients with OHCA, 576 were enrolled (median age 73 years; 334 men). A higher QRS amplitude was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (adjusted OR (aOR) 1.077 and 1.106, respectively; 95% CI 1.021 to 0.136 and 1.029 to 1.190, respectively) and model 2 (aOR 1.084 and 1.123, respectively; 95% CI 1.026 to 1.145 and 1.036 to 1.216, respectively). A QRS width of <120 ms was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (aOR 3.371 and 4.634, respectively; 95% CI 1.633 to 6.960 and 1.562 to 13.144, respectively) and model 2 (aOR 3.213 and 5.103, respectively; 95% CI 1.568 to 6.584 and 1.682 to 15.482, respectively). Survival to hospital discharge and neurological outcome were not associated with QRS frequency.ConclusionOHCA-P outcomes were better when the initial QRS complex showed a higher amplitude or narrower width.

Download Full-text

The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10235573 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5573

Author(s):

Karol Bielski ◽

Agnieszka Szarpak ◽

Miłosz Jaroslaw Jaguszewski ◽

Tomasz Kopiec ◽

Jacek Smereka ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Hospital Discharge ◽

Meta Analysis ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Survival Outcomes ◽

Cochrane Central Register ◽

Mortality And Morbidity ◽

Hospital Cardiac Arrest

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

Download Full-text