Abstract 150: Impact of Epinephrine on ECG Changes During Resuscitation From Out-of-Hospital Cardiac Arrest With Initial Pulseless Electrical Activity

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Gunnar W Skjeflo ◽  
Eirik Skogvoll ◽  
Jan Pål Loennechen ◽  
Theresa M Olasveengen ◽  
Lars Wik ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Multivariate Regression ◽  
Life Support ◽  
Controlled Trial ◽  
Pulseless Electrical Activity ◽  
Qrs Complex ◽  
Epinephrine Administration ◽  
Hospital Cardiac Arrest

Introduction: Presence of electrocardiographic rhythm, documented by the electrocardiogram (ECG), in the absence of palpable pulses defines pulseless electrical activity (PEA). Our aims were to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-Hospital-Cardiac-Arrest (OHCA) with initial PEA, and to explore the effects of epinephrine on these characteristics. Methods: Patients with OHCA and initial PEA in a randomized controlled trial of ALS with or without intravenous access and medications were included. QRS widths and heart-rates were measured in recorded ECG signals during pauses in compressions. Statistical analysis was carried out by multivariate regression (MANOVA). Results: Defibrillator recordings from 170 episodes of cardiac arrest were analyzed, 4840 combined measurements of QRS complex width and heart rate were made. By the multivariate regression model both whether epinephrine was administered and whether return of spontaneous circulation (ROSC) was obtained were significantly associated with changes in QRS width and heart rate. For both control and epinephrine groups, ROSC was preceded by decreasing QRS width and increasing rate, but in the epinephrine group an increase in rate without a decrease in QRS width was associated with poor outcome (fig). Conclusion: The QRS complex characteristics are affected by epinephrine administration during ALS, but still yields valuable prognostic information.

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

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.

scholarly journals UK ambulance service resuscitation management of pulseless electrical activity: a systematic review protocol of text and opinion

2020 ◽  
Vol 5 (1) ◽  
pp. 20-25
Author(s):  
Alison Coppola ◽  
Sarah Black ◽  
Sasha Johnston ◽  
Ruth Endacott
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Life Support ◽  
Guideline Implementation ◽  
Pulseless Electrical Activity ◽  
Ambulance Service ◽  
Synthesis Process ◽  
Reference List ◽  
Hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest patients with pulseless electrical activity are treated by paramedics using basic and advanced life support resuscitation. When resuscitation fails to achieve return of spontaneous circulation, there are limited evidence and national guidelines on when to continue or stop resuscitation. This has led to ambulance services in the United Kingdom developing local guidelines to support paramedics in the resuscitative management of pulseless electrical activity. The content of each guideline is unknown, as is any association between guideline implementation and patient survival. We aim to identify and synthesise local ambulance service guidelines to help improve the consistency of paramedic-led decision-making for the resuscitation of pulseless electrical activity in out-of-hospital cardiac arrest.Methods: A systematic review of text and opinion will be conducted on ambulance service guidelines for resuscitating adult cardiac arrest patients with pulseless electrical activity. Data will be gathered direct from the ambulance service website. The review will be guided by the methods of the Joanna Briggs Institute (JBI). The search strategy will be conducted in three stages: 1) a website search of the 14 ambulance services; 2) a search of the evidence listed in support of the guideline; and 3) an examination of the reference list of documents found in the first and second stages and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Each document will be assessed against the inclusion criteria, and quality of evidence will be assessed using the JBI Critical Appraisal Checklist for Text and Opinion. Data will be extracted using the JBI methods of textual data extraction and a three-stage data synthesis process: 1) extraction of opinion statements; 2) categorisation of statements according to similarity of meaning; and 3) meta-synthesis of statements to create a new collection of findings. Confidence of findings will be assessed using the graded ConQual approach.

Abstract 232: Delayed Administration of Epinephrine is Associated with Worse Neurological Outcomes in Patients with Out-of-hospital Cardiac Arrest and Initial Pulseless Electrical Activity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Nobuyuki Enzan ◽  
Ken-ichi Hiasa ◽  
Kenzo Ichimura ◽  
Masaaki Nishihara ◽  
Takeshi Iyonaga ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Pulseless Electrical Activity ◽  
Cubic Spline ◽  
Epinephrine Administration ◽  
Neurological Outcomes ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background: Delayed administration of epinephrine has been proven to worsen the neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA) and initial shockable rhythm. We aimed to investigate whether delayed administration of epinephrine might also worsen the neurological outcomes of patients with witnessed OHCA and initial pulseless electrical activity (PEA). Methods: The Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry is a multicenter, prospective, observational registry including 34,754 OHCA patients between 2014 and 2017. The present study assessed the impact of the time to epinephrine administration on neurological outcomes in patients with witnessed non-traumatic OHCA with initial rhythm of PEA. The primary outcome was defined as Cerebral Performance Categories (CPC) Scale 1-2 at 30 days after OHCA. The association between the odds ratio for the primary outcome and the time from witnessed OHCA to epinephrine administration was assessed with a restricted cubic spline analysis. Results: Out of 34,754 patients with OHCA, 3,050 patients with OHCA and initial PEA who received epinephrine were included in the present study. Mean age was 73.7 years and 1836 (60.2%) was male. After adjusting for potential confounders, the time from witnessed OHCA to epinephrine administration was associated with lower likelihood of favorable neurological outcomes (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.89-0.96; P&lt;0.001). The restricted cubic spline analysis demonstrated that delayed epinephrine administration could decrease the likelihood of a favorable neurological outcome; this was significant within the first 10 minutes. Conclusions: Delayed administration of epinephrine was associated with worse neurological outcomes in patients with witnessed OHCA patients with initial PEA.

scholarly journals Cessation of Resuscitation in Pulseless Electrical Activity Out of Hospital Cardiac Arrest: A Mixed Methods Study of Senior Paramedic Decision Making

2020 ◽  
Author(s):  
Alison Coppola ◽  
Sarah Black ◽  
Ruth Endacott
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Clinical Features ◽  
Life Support ◽  
Pulseless Electrical Activity ◽  
Advanced Life Support ◽  
Patient Characteristics ◽  
System Factors ◽  
Hospital Cardiac Arrest

Abstract BackgroundPulseless electrical activity, a non-shockable cardiac arrest, is treated using advanced life support resuscitation. Typically, survival rates are poor and there is a paucity of evidenced-based guidelines for paramedics on when to cease resuscitation. This led to one UK Ambulance Service developing a local guideline to support senior paramedics when making cessation decisions. This study aimed to describe the patient characteristics, clinical features and system factors of pulseless electrical activity and explore the experiences of senior paramedics making autonomous cessation decisions. Design and MethodsAn explanatory sequential mixed method design conducted in a single UK Ambulance Service. Data was retrieved for all adult Out of Hospital Cardiac Arrest patients from 1st December 2015 to 31st December 2018. Cases subject to a coronial or police investigation were excluded. Senior paramedics ceased resuscitation for 50 PEA patients, a consecutive sample, which was reviewed in detail using descriptive statistics. Independent t-test and Chi Square examined associations between variables known to prognosticate survival. Interviews were conducted with six senior paramedics who remotely supported on-scene paramedics and findings were analysed using content framework analysis. ResultsPatient characteristics: Mean age 78 years, male (n=30, 60%), co-morbidities (n=40, 80%), witnessed collapse (n=37, 74%), bystander BLS (n=30, 60%). Clinical features: defibrillation (n=22, 44%), ROSC (n=8, 16%), heart rate< 50 (n=46, 92%), mean ETCO2 2.3kPa. System factors: Advanced life support duration 59mins. A significant association between witnessed cardiac arrest and bystander basic life support was found (95% p=.00). Themes arising from interviews were defining resuscitation futility, the impact of ceasing resuscitation, conflicting views and clinical decision tools. ConclusionSenior paramedics interpreted and applied a multifactorial approach to ceasing resuscitation for patients with PEA. Patient characteristics, clinical features and system factors were balanced using clinical judgement, found to be vital to the decision-making process. This finding questions the appropriateness of paramedics making cessation decisions based on clinical features alone. As prognostic factors for survival were present, further investigation to identify the difference between an unsuccessful or futile resuscitation is required.

Resuscitation for Patients with Out-of-Hospital Cardiac Arrest: Singapore

2002 ◽  
Vol 17 (2) ◽  
pp. 96-101 ◽  
Author(s):  
Ghee Hian Lim ◽  
Eillyne Seow
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Hospital Setting ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Very High Frequency ◽  
Traumatic Cardiac Arrest ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest ◽  
Very High

AbstractAim:To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients.Method:All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation.Results:Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 ±3.36 minutes for the survivors and 11.8 ±4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 ±4.61 minutes for the survivors and 12.0 ±4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 ±8.32 minutes for the survivors and 37.2 ±9.00 minutes for the non-survivors.Conclusion:The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is ≥30 minutes coupled with no ROSC, and if continuous asystole has been documented for >10 minutes.

Abstract 39: Atropine for Patients with Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ken Nagao ◽  
Tetsuya Sakamoto ◽  
Masaki Igarashi ◽  
Shinichi Ishimatsu ◽  
Akira Sato ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Life Support ◽  
Multiple Logistic Regression Analysis ◽  
Pulseless Electrical Activity ◽  
Similar Frequency ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

BACKGROUND AHA guidelines for cardiopulmonary resuscitation (CPR) have recommended that administration of atropine can be considered for asystole or pulseless electrical activity (PEA), because atropine has improved survival to hospital admission in a retrospective review (Ann Emerg Med, 1984), and is inexpensive, easy to administer, and has few side effects. However, there are insufficient data in humans. METHODS We assessed the effects of atropine in 7,443 adults patients with asystole or PEA arrest from the SOS-KANTO study: a prospective, multicenter, observational trial. The medications for asystole or PEA arrest were managed according to the advanced cardiovascular life support algorithm of the CPR guidelines (i.e. a 1-mg dose of epinephrine was administered intravenously every 3 to 5 minutes and a1-mg dose of atropine was administered intravenously every 3 to 5 minutes; maximum total of 3 doses). The primary endpoint was a favorable neurological outcome 30 days after cardiac arrest. RESULTS Of the 7,443 adult patients who had out-of-hospital cardiac arrest with asystole or PEA, I,708(23%) were treated with epinephrine and atropine and 5,735(77%) were treated with epinephrine. At baseline, the epinephrine and atropine group had significantly higher proportions of cardiac cause, witnessed arrest, and bystander CPR attempt than the epinephrine group. However, the two groups had a similar frequency of the favorable neurological outcome (0.3% in each group, p=0.805). Multiple logistic-regression analysis showed that the adjusted odds ratio for the favorable neurological outcome was 0.6 (95% CI 0.2–1.7, p=0.37) after epinephrine and atropine (compared with epinephrine). On the other hand, the epinephrine and atropine group had significantly higher rate of return of spontaneous circulation (ROSC) than the epinephrine group (35% vs. 23%, p<0.0001), and the adjusted odds ratio for ROSC was 1.6 (95% CI 1.4 –1.7, p<0.0001) after epinephrine and atropine (compared with epinephrine). CONCLUSIONS We demonstrated that administration of atropine during management of asystole or PEA arrest did not increase the frequency of favorable neurological outcome, although the atropine favored initial ROSC.

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