Abstract 9740: Factors Associated With Performing Urgent Coronary Angiography in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
David H Lam ◽  
Lauren M Glassmoyer ◽  
Roger B Davis ◽  
Donald E Cutlip ◽  
Michael W Donnino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Medical Center ◽  
Academic Medical Center ◽  
Do Not Resuscitate ◽  
Factors Associated ◽  
Shockable Rhythm ◽  
History Of ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and is most commonly caused by cardiovascular disease. Current guidelines recommend urgent coronary angiography (UCA) if ST-elevation myocardial infarction (STEMI) or high suspicion of acute myocardial infarction exist. Some have advocated for UCA in all OHCA without an obvious non-cardiac cause of arrest. The reasons for large clinical variation in performance of UCA in OHCA are not well understood. Objective: We sought to identify factors associated with performing UCA in OHCA. Methods: A retrospective chart review was conducted on 535 consecutive cardiac arrest patients who achieved return of spontaneous circulation (ROSC) and were admitted at a tertiary academic medical center from January 2008 to August 2014. Exclusion criteria included in-hospital cardiac arrests (201), outside hospital UCA (8), and lack of medical records (1). Univariable analysis followed by multivariable forward selection forcing age and gender were used to determine correlates of performing UCA, defined as within 6 hours of presentation. Results: Out of 325 resuscitated OHCA patients (mean age, 64; women, 35%), 69 were taken to UCA. Factors associated with performing UCA were history of coronary artery disease (CAD) (OR 2.76, 95% CI 1.22-6.28), initial shockable rhythm (OR 3.04, 95% CI 1.31-7.06), following commands post-ROSC (OR 2.77, 95% CI 1.06-7.25), and STEMI (OR 15.17, 95% CI 6.57-35.04). Increasing age (OR 0.97, 95% CI 0.95-0.999) and obvious non-cardiac cause of arrest (OR 0.10, 95% CI 0.03-0.37) were negatively associated. Gender, prior stroke, dementia, bystander cardiopulmonary resuscitation, hypotension, contraindication to anticoagulant, presenting from nursing home or rehabilitation, do not resuscitate order prior to admission, non-English primary language, and presenting during off-hours were not associated with the decision for UCA. Conclusions: In resuscitated out-of-hospital cardiac arrest patients, history of CAD, shockable rhythm, ability to follow commands, and STEMI were associated with performing urgent coronary angiography. Older patients and those with an obvious non-cardiac cause of arrest were less likely to receive coronary angiography.

scholarly journals Survival of In-Hospital Cardiac Arrest in COVID-19 Infected Patients

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1315
Author(s):  
Mohammad Aldabagh ◽  
Sneha Wagle ◽  
Marie Cesa ◽  
Arlene Yu ◽  
Muhammad Farooq ◽  
...  
Keyword(s):  
New York ◽  
Cardiac Arrest ◽  
Medical Center ◽  
Survival Rates ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Shockable Rhythm ◽  
Artery Disease ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Background: There are limited data regarding the outcome of in-hospital cardiopulmonary resuscitation (CPR) in COVID-19 patients. In this study, we compared the outcomes of in-hospital cardiac arrests (IHCA) before and at the peak of the COVID-19 pandemic at Montefiore Medical Center in the Bronx, New York, United States. We also identified the most common comorbidities associated with poor outcomes in our community. Methods: This was a multi-site, single-center, retrospective, observational study. Inclusion criteria for COVID patients were all confirmed positive cases who had in-hospital cardiac arrest (IHCA) between 1 March 2020 and 30 June 2020. The non-COVID cohort included all cardiac arrest cases who had IHCA in 2019. We excluded all out-of-hospital cardiac arrest (OHCA). We compared actual survival to that predicted by the GO-FAR score, a validated prediction model for determining survival following IHCA. Results: There were 334 cases in 2019 compared to 450 cases during the specified period in 2020. Patients who initially survived cardiac arrest but then had their code statuses changed to do not resuscitate (DNR) were excluded. Groups were similar in terms of sex distribution, and both had an average age of about 66 years. Seventy percent of COVID patients were of Black or Hispanic ethnicity. A shockable rhythm was present in 7% of COVID patients and 17% of non-COVID patients (p < 0.05). COVID patients had higher BMI (30.7 vs. 28.4, p < 0.05), higher prevalence of diabetes mellitus (58% vs. 38%, p < 0.05), and lower incidence of coronary artery disease (22% vs. 35%, p < 0.05). Both groups had almost similar predicted average survival rates based on the GO-FAR score, but only 1.5% of COVID patients survived to discharge compared to 7% of non-COVID patients (p < 0.05). Conclusion: The rate of survival to hospital discharge in COVID-19 patients who suffer IHCA is worse than in non-COVID patients, and lower than that predicted by the GO-FAR score. This finding may help inform our patient population about risk factors associated with high mortality in COVID-19 infection, as well as educate hospitalized patients and healthcare proxies in the setting of code status designation.

Abstract 18040: Effect on Survival of an Early versus Late Coronary Angiography Approach in Patients With Out-of-hospital Cardiac Arrest Without ST-Segment Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David F Miranda ◽  
Yader Sandoval ◽  
Steven R Goldsmith ◽  
Bradley A Bart ◽  
Fouad A Bachour
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Controlled Trial ◽  
Optimal Timing ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Shockable Rhythm ◽  
St Segment ◽  
Hospital Cardiac Arrest

Background: The optimal timing of coronary angiography (CA) if performed in the management of patients presenting with out-of-hospital cardiac arrest (OHCA) in the absence of ST-Segment elevation myocardial infarction (STEMI) has not been examined by any randomized controlled trial (RCT), though some retrospective studies have suggested benefit of an early approach. Methods: We performed a retrospective analysis of 93 consecutive patients with OHCA and shockable rhythm, without STEMI between July 2007 and April 2014. Patients were categorized by those receiving early (24 hrs.) CA, and the relationship between timing of CA and mortality was assessed, along with key relevant clinical and angiographic variables in each group (Table). Results: Among 93 patients, 45 (48%) received early CA and 48 (52%) late CA. Door-to-angiography median time was 69 (50, 89) minutes in patients undergoing early CA. Patients undergoing early CA were more likely to have a culprit lesion on CA (31% vs. 10%, p=0.01), and a trend toward more frequent PCI (31% vs. 15%, p =0.06) in comparison to late CA. However, they also had a higher baseline lactate level. Inpatient mortality was significantly higher in patients undergoing early CA (27%) compared to those undergoing late CA (4%) (p=0.002). Conclusions: In a series of 93 consecutive patients presenting with OHCA without STEMI, early CA was associated with higher mortality despite a higher frequency of culprit lesions and successful PCI. These results contrast with those from other post-hoc analyses and clearly demonstrate the need for a RCT comparing early vs. late CA in this patient population.

Abstract 25: Early Coronary Angiography and Survival After Out-Of-Hospital Cardiac Arrest

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ankur Vyas ◽  
Paul Chan ◽  
Bryan McNally ◽  
Saket Girotra
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Propensity Score Analysis ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
C Statistic ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are common rhythms seen in out-of-hospital cardiac arrest (OHCA). Although acute myocardial infarction is a frequent cause of VF and pulseless VT, it is unknown whether a strategy of early coronary angiography is associated with improved survival in patients with OHCA. Methods: Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 1810 adult patients who had an OHCA due to VF, pulseless VT, or an unknown but shockable rhythm and were successfully resuscitated and admitted to a hospital. Using a matched propensity score analysis, we examined the association between a strategy of early coronary angiography within the first day of cardiac arrest and survival to discharge. Results: Early coronary angiography was performed in 874 (48.3%) patients, of whom 523 (59.8%) received coronary stents. Compared to those without early angiography, patients undergoing early coronary angiography were younger (59.9 vs. 62.5 years); more likely to be men (77.9% vs. 64.5%), have a witnessed arrest (86.3% vs. 76.7%), have a diagnosis of ST-elevation myocardial infarction (STEMI) (68.5% vs. 20.3%); and less likely to have known cardiovascular disease (37.3% vs. 54.3%), diabetes (15.4% vs. 26.6%), and renal disease (3.7% vs. 8.3%) (P <0.01 for all comparisons). A total of 565 patients without early angiography were successfully matched to 565 patients with early coronary angiography (c-statistic of 0.77). A strategy of early coronary angiography was associated with higher rates of in-hospital survival (adjusted OR: 1.22, [1.02- 1.45], P=0.025). There were no differences in favorable neurological outcome between the two groups (adjusted OR: 1.10, [0.98-1.23], P=0.12). Conclusion: Among patients with an OHCA due to VF or pulseless VT who were successfully resuscitated and admitted to a hospital, a strategy of early coronary angiography was associated with better survival, which was not compromised by worse neurological outcomes. Given that many patients with an OHCA due to VF or pulseless VT do not currently undergo early coronary angiography, randomized trials are needed to confirm whether a strategy of early coronary angiography can improve outcomes in patients with OHCA.

scholarly journals Admission biomarkers among patients with acute myocardial-infarction related cardiogenic shock with or without out-of-hospital cardiac arrest

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Thoegersen ◽  
M Frydland ◽  
O Helgestad ◽  
LO Jensen ◽  
J Josiassen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Cardiogenic Shock ◽  
Plasma Concentrations ◽  
Endothelial Damage ◽  
Soluble Thrombomodulin ◽  
Catheterization Laboratory ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Lundbeck Foundation OnBehalf Critical Cardiac Care Research Group Background Approximately half of all patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) present with out-of-hospital cardiac arrest (OHCA). Cardiogenic shock due to OHCA is caused by abrupt cessation of circulation, whereas AMICS without OHCA is due to cardiac failure with low cardiac output. Thus, there may also be differences between the two conditions in terms of blood borne biomarkers. Purpose To explore the potential differences in the admission plasma concentrations of biomarkers reflecting tissue perfusion (lactate), neuroendocrine response (mid-regional proadrenomedullin [MRproADM], Copeptin, pro-atrial natriuretic peptide [proANP]), endothelial damage (Syndecan-1, soluble thrombomodulin [sTM]), inflammation (soluble suppression of tumorigenicity 2 [sST2]) and kidney injury (neutrophil gelatinase-associated lipocalin [NGAL]), in patients with AMICS presenting with or without OHCA. Method Consecutive patients admitted for acute coronary angiography due to suspected ST-elevation myocardial infarction (STEMI) were enrolled during a 1-year period. A total of 2,713 patients were screened. In the present study 86 patients with confirmed STEMI and CS at admission were included. Results Patients with OHCA (had significantly higher median admission concentrations of Lactate (6,9 mmol/L vs. 3.4 mmol/L p &lt;0.001), NGAL (220 ng/ml  vs 150 ng/ml p = 0.046), sTM (10 ng/ml vs. 8.0  ng/ml p = 0.026) and Syndecan-1 (160 ng/ml vs. 120 ng/ml p= 0.015) and significantly lower concentrations of MR-proADM (0.85 nmol/L  vs. 1.6 nmol/L p &lt;0.001) and sST2 (39 ng/ml vs. 62 ng/ml p &lt; 0.001).  After adjusting for age, sex, and time from symptom onset to coronary angiography, lactate (p = 0.008), NGAL (p = 0.03) and sTM (p = 0.011) were still significantly higher in patients presenting with OHCA while sST2 was still significantly lower (p = 0.029). There was very little difference in 30-day mortality between the OHCA and non-OHCA groups (OHCA 37% vs. non-OHCA 38%). Conclusion Patients with STEMI and CS at admission with or without concomitant OHCA had similar 30-day mortality but differed in terms of Lactate, NGAL, sTM and sST2 levels at the time of admission to catheterization laboratory. These findings propose that non-OHCA and OHCA patients with CS could be considered as two individual clinical entities. Abstract Figure. Level of biomarkers OHCA vs. non-OHCA

COMPARISON OF EARLY VERSUS DELAYED CORONARY ANGIOGRAPHY IN OUT-OF-HOSPITAL CARDIAC ARREST WITHOUT ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

2020 ◽  
Vol 75 (11) ◽  
pp. 1355
Author(s):  
Muhammad Khalid ◽  
Ghulam Murtaza ◽  
Muhammad Talha Ayub ◽  
Varun Kohli ◽  
Rajesh Sachdeva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Hospital Cardiac Arrest

Abstract 9160: Epinephrine-Dominant versus Non-Epinephrine Dominant Resuscitation for In-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jennifer W Chou ◽  
Amy Lin ◽  
Juan Toledo ◽  
Gabriel Wardi ◽  
Katrina Derry ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Diastolic Pressure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cerebral Performance Category ◽  
Myocardial Oxygen Demand ◽  
Coronary Perfusion ◽  
Dose Ratio ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Vasopressors are used during CPR to increase arterial resistance and aortic diastolic pressure, improving coronary perfusion and likelihood of ROSC. In comparison to epinephrine, vasopressin remains effective in an acidemic environment, has favorable cerebral perfusion, and does not directly increase myocardial oxygen demand. Studies comparing epinephrine and vasopressin report variable ROSC, survival, and neurological outcome. Most studies used few vasopressin doses and it is unclear whether greater vasopressin use leads to clinical benefit. Hypothesis: We hypothesized that a non-epinephrine dominant CPR approach with vasopressin would lead to greater ROSC than an epinephrine-dominant approach. Methods: This was a retrospective, single-center study conducted at an 800-bed academic medical center. All first cardiac arrests among adult inpatients between Jan 2018 and Mar 2021 were screened, and those with at least 2 vasopressor doses used were included. Patients who received epinephrine-dominant resuscitation (epinephrine-to-vasopressin dose ratio >2 or CPR using only epinephrine) were compared to patients who received a non-epinephrine dominant approach (epinephrine-to-vasopressin dose ratio ≤2). The incidence of ROSC was analyzed using a Chi-squared test where p <0.05 was considered significant. Secondary outcomes included survival to discharge with favorable neurologic outcome, survival to discharge, and Cerebral Performance Category scores. Results: Of 663 in-hospital cardiac arrests screened, 264 were included. Two hundred twenty-eight (86%) presented with PEA/asystole as the initial rhythm, and the most common etiologies were circulatory (41%) and respiratory (26%). The epinephrine-dominant arm achieved ROSC in 89 (66%) patients compared to 87 (67%) patients in the non-epinephrine dominant arm (RR 0.99, 95% CI 0.84-1.18, p=0.93). Survival to discharge was higher in the epinephrine-dominant arm (25% vs 15%, p=0.04). Conclusion: There was no difference in ROSC between epinephrine-dominant and non-epinephrine dominant resuscitation for adult in-hospital cardiac arrest. Future studies should examine the impact of non-epinephrine dominant CPR on long term neurologic outcomes.

Impact of puberty as threshold to differentiate outcome of out-of-hospital cardiac arrest care groups: a nationwide observational study in France

2021 ◽  
pp. emermed-2020-210447
Author(s):  
Elodie Privat ◽  
Valentine Baert ◽  
Joséphine Escutnaire ◽  
Cyrielle Dumont ◽  
Morgan Recher ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Observational Study ◽  
Children And Adolescents ◽  
International Guidelines ◽  
Factors Associated ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Adolescents And Adults ◽  
Nationwide Observational Study ◽  
Hospital Cardiac Arrest

BackgroundSince 2005, the international guidelines for out-of-hospital cardiac arrest (OHCA) use puberty to differentiate paediatric and adult care. This threshold is mainly relied on the more frequent respiratory aetiologies in children. Hitherto, to the best of our knowledge, no study has compared the characteristics and outcomes of non-pubescent children, adolescents and adult patients with OHCA. In this study, we intended to describe the characteristics, outcome and factors associated with survival of patients who experienced OHCA in the three groups: children, adolescents (pubescent<18 years) and adults (<65 years), to assess the pertinence of the guidelines.MethodsData from the French national cardiac arrest registry (2012–2017) were used in this nationwide observational study. Victims of OHCA who were <65 years old were included. The characteristics and outcomes of children and adolescents, and adolescents and adults were compared. Logistic regression was performed in each group to identify factors associated with survival at day 30.ResultsWe included 934 children, 433 adolescents and 26 952 adults. Respiratory aetiology was more frequent and shockable rhythm less frequent in children compared with adolescents (25.5% vs 17.2%, p=0.025 and 2.4% vs 6.8%, p<0.001, respectively). However, these differences were not observed between adolescents and adults (17.2% vs 14.1%, p=0.266 and 6.8% vs 10%, p=0.055, respectively). Between children and adolescents, and adolescents and adults, there was no significant difference in survival at day 30 (8.6%vs 9.8% and 9.8% vs 8.5%, respectively). For all groups, shockable initial rhythm was a factor of survival.ConclusionFrequency of respiratory aetiologies and shockable rhythm were common in adolescents and adults and different between children and adolescents. These results indicate that puberty as a threshold in international guidelines seems to be relevant.

scholarly journals THE EFFECT OF A CHECKLIST ON VARIABILITY OF CARE AFTER IN HOSPITAL CARDIAC ARREST AT A TERTIARY ACADEMIC MEDICAL CENTER

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1049
Author(s):  
Vince Raikhel ◽  
Stephen Ferraro ◽  
David Carlbom ◽  
Vera Schulte ◽  
James Town
Keyword(s):  
Cardiac Arrest ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Hospital Cardiac Arrest
Sign in / Sign up

Export Citation Format

Share Document