Abstract 246: The Relationship Between Favorable Neurological Outcome in Patients With Out-of-Hospital Cardiac Arrest Due to Cardiac Etiology and Regional Disparity of the Number of Physicians

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Shigemasa Tani ◽  
Eizo Tachibana ◽  
Nobutaka Chiba ◽  
...  
Keyword(s):  
Public Health ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Public Health Problem ◽  
Regional Disparity ◽  
Major Public Health Problem ◽  
Favorable Neurological Outcome ◽  
The Relationship ◽  
Hospital Cardiac Arrest

Background: Cardiac arrest is a major public health issue worldwide. In Japan, the regional disparity of the number of physicians per 100000 population is also a major public health problem. However, it is unknown whether there is the relationship between favorable neurological outcome in patients with out-of-hospital cardiac arrest (OHCA) due to cardiac etiology and this regional disparity. The aim of the present study was to clarify this relationship using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA. Methods: From the data of the All-Japan Utstein Registry between 2011 and 2015, we included adult patients who had OHCA due to cardiac etiology. 47 prefectures of Japan were divided into quartiles on the basis of the number of physicians in each prefecture, reported by Ministry of Health, Labor and Welfare in Japan. In addition, study patients were divided into four groups based on these quartiles. We compared favorable neurological outcome at 30 days after OHCA in each group, using the multivariable logistic-regression analysis. Results: Four quartile ranges of the number of physicians were set for this study (Figure). Moreover, of the 629,471 OHCA victims between 2011 and 2015, 358,993 met the inclusion criteria. Figure represented favorable neurological outcome at 30 days after OHCA in each quartile. In the multivariable analysis, the adjusted odds ratios for Quartile 2, Quartile 3 and Quartile 4 compared with Quartile 1 for favorable neurological outcome at 30 days after OHCA was 0.971 (95%CI 0.918- 1.027; P=0.307), 1.011 (95%CI 0.956- 1.069; P=0.703) and 0.850 (95%CI 0.809- 0.893; P<0.001), respectively. Conclusion: The regions in which the number of physicians per 100000 population was larger were inferior to the regions in which the number of these was smaller, in terms of neurological benefits in patients with OHCA due to cardiac etiology.

Abstract 347: The Effect of Targeted Temperature Management at 34 °C and 36 °C on Day-30 Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Takeshi Iyonaga ◽  
Ken-ichi Hiasa ◽  
Nobuyuki Enzan ◽  
Masaaki A Nishihara ◽  
Kenzo Ichimura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Target Temperature ◽  
Neurological Outcomes ◽  
Favorable Neurological Outcome ◽  
The Relationship ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) has established evidence for improving neurological outcomes in cardiac arrest patients who sustained coma after return of spontaneous circulation (ROSC). The target temperature has been recommended to be between 32 and 36 °C. However optimal temperature remains unestablished. This study aimed to assess the relationship between target temperature and neurological outcome by using the Japanese nationwide registry. Methods: This retrospective observational cohort study was based on the Japanese association for acute medicine - out-of-hospital cardiac arrest (JAAM-OHCA) registry during 2014 to 2017. Our study included all initial rhythms and any cause of OHCA patients and excluded age < 18 and Glasgow Coma Scale score > 8. The primary outcome was 30 day favorable neurological outcome, defined as cerebral performance category (CPC) scale 1 and 2. First, to clarify the efficacy of TTM, the neurological outcome was compared whether patients received TTM or not. Next, to evaluate the relationship between neurological outcome and target temperature on TTM, the neurological outcome was compared hypothermia (34 °C) group with normothermia (36 °C) group . Single and multivariable logistic regression analysis was performed. Results: The study included 9930 patients. Of these, 1184 (11.9%) patients received TTM. Favorable neurological outcome was more present in TTM group than in no TTM group (39.7% vs. 4.3%, odds ratio [OR] 14.6, 95% confidence interval [CI] 12.5-17.1, p<0.001). Multivariable analysis showed TTM was associated with favorable neurological outcome (OR 1.6, 95%CI 1.1-2.3, p<0.001). Of TTM group, 801 (68.5%) patients received hypothermia management and 242 (20.7%) patients received normothermia management. Favorable neurological outcome was more present in the hypothermia group than in the normothermia group (42.6% vs. 34.3%, OR 1.42, 95% CI 1.1-1.9, p=0.022). However, the neurological outcome did not differ between these two groups (OR 0.84, 95%CI 0.46-1.5, p<0.57). Conclusions: TTM was significantly associated with favorable neurological outcome. However, neurological outcome was not associated with target temperature on TTM.

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

Circulation ◽  
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.

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 ◽  
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.

Abstract 155: Effect of the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest Due to Shockable Rhythm

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Yoji Watanabe ◽  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Shigemasa Tani ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome ◽  
Population Based Registry ◽  
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. Especially, the 2010 guidelines recommended that comatose adult patients with ROSC after out-of-hospital ventricular fibrillation (VF) cardiac arrest should be induced therapeutic hypothermia (Class I). However, it is unknown whether the post-cardiac arrest care which was recommended by the 2010 guidelines 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 shockable rhythm, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest (OHCA). Methods: From the data of this registry between 2005 and 2015, we included adult patients with ROSC after out-of-hospital 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 primary endpoint was favorable neurological outcome at 30 days after OHCA. Results: The 30,518 patients who met the inclusion criteria comprised 24,729 with ROSC before arrival at the hospital and 5,789 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 shockable cardiac arrest, the 2010 guidelines were superior to the 2005 guidelines and the 2000 guidelines, in terms of neurological benefits.

Abstract 199: Pulmonary Embolism and Accidental Hypothermia Have a Favorable Outcome in Cardiac Arrest With PEA Treated by ECPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shinichi Ijuin ◽  
Akihiko Inoue ◽  
Nobuaki Igarashi ◽  
Shigenari Matsuyama ◽  
Tetsunori Kawase ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Accidental Hypothermia ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Group B ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also not significantly different (Group G; 46.1 ± 20.2 min vs Group B; 46.8 ± 21.7 min, p=0.92). Ten patients achieved favorable neurological outcome among 39 (26%) with non-cardiac etiology. In cardiac etiology, only 3 of 29 patients (9%) had a good outcome at 1 month (p=0.08). In particular, 5 patients of 10 pulmonary embolism, and 4 of 4 accidental hypothermia responded well to ECPR with a favorable neurological outcome. Additionally, 6 of 13 (46%), who had in hospital cardiac arrest, had good outcome, whereas 7 of 55 (15%) who had out of hospital cardiac arrest, had good outcome (p=0.02). Conclusions: In our small cohort of cardiac arrest patients with pulmonary embolism or accidental hypothermia and PEA with witness, EPCR contributed to favorable neurological outcomes at 1 month.

Abstract 588: Extracorporeal Cardiopulmonary Resuscitation for Induction of Hypothermia in Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ken Nagao ◽  
Kimio Kikushima ◽  
Kazuhiro Watanabe ◽  
Eizo Tachibana ◽  
Takaeo Mukouyama ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Control Group ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hypothermia Group ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Therapeutic hypothermia is beneficial to neurological outcome for comatose survivors after out-of-hospital cardiac arrest. However, there are few data of extracorporeal cardiopulmonary resuscitation (ECPR) for induction of hypothermia for patients with out-of-hospital cardiac arrest. We did a prospective study of ECPR with hypothermia for patients with out-of-hospital cardiac arrest. The criteria for inclusion were an age of 18 to 74 years, a witnessed cardiac arrest, collapse-to-patient’s-side interval <15 minutes, cardiac arrest due to presumed cardiac etiology, and persistent cardiac arrest on ER arrival in spite of the prehospital defibrillations. After arrival at the emergency room, cardiopulmonary bypass plus intra-aortic balloon pumping was immediately performed, and then coronary reperfusion therapy during cardiac arrest was added if needed. Mild hypothermia (34°C for 3 days) was immediately induced during cardiac arrest or after return of spontaneous circulation. We selected suitable patients who received conventional CPR with normothermia among a prospective multi-center observational study of patients who had out-of-hospital cardiac arrest in Kanto region of Japan “the SOS-KANTO study” for the control group. The primary endpoint was favorable neurological outcome at the time of hospital discharge. A total of 558 patients were enrolled; 127 received ECPR with hypothermia and 431 received conventional CPR with normothermia. The ECPR with hypothermia group had significantly higher frequency of the favorable neurological outcome than the conventional CPR with normothermia group (12% vs. 2%, unadjusted odds ratio, 8.1; 95% CI; 3.2 to 20.0). The adjusted odds ratio for the favorable neurological outcome after ECPR with hypothermia was 7.4 (95% CI; 2.8 to 19.3, p<0.0001). Among the ECPR with hypothermia group, early attainment of a target core temperature of 34°C increased its efficacy (adjusted odds ratio, 0.99; 95% CI; 0.98 to 1.00, p=0.04). ECPR with hypothermia improved the chance of neurologically intact survival for adult patients with out-of-hospital cardiac arrest, and the early attainment of a target temperature enhanced its efficacy.

Abstract 208: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome in Patients With Refractory Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Takashi Unoki ◽  
Daisuke Takagi ◽  
Yudai Tamura ◽  
Hiroto Suzuyama ◽  
Eiji Taguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Intervention Period ◽  
Post Intervention ◽  
Shockable Rhythm ◽  
Time Period ◽  
Simulation Based ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Prolonged conventional cardiopulmonary resuscitation (C-CPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with cardiac arrest unresponsive to C-CPR. However, the indication and optimal duration to switch from C-CPR to E-CPR are not well established. In addition, the opportunities to develop teamwork skills and expertise to mitigate risks are few. We thus developed the implementation protocol for the E-CPR simulation program, and investigated whether the faster deployment of extracorporeal membrane oxygenation (ECMO) improves the neurological outcome in patients with refractory OHCA. Methods: A total of 42 consecutive patients (age 58±16 years, male ratio 90%, and initial shockable rhythm 64%) received E-CPR (3% of OHCA) during the study period. Among them, 32 (76%) were deployed ECMO during the pre-intervention time period (Pre: from January 2012 to September 2017), whereas 10 (24%) were deployed during the post-intervention time period (Post: October 2017 to May 2019). We compared the door to E-CPR time, collapse to E-CPR time, 30-day mortality, and favorable neurological outcome (Cerebral Performance Categories 1, 2) between the two periods. Results: There was no significant difference in age, the rates of male sex and shockable rhythm, and the time form collapse to emergency room admission between the two periods. The door to E-CPR time and the collapse to E-CPR time were significantly shorter in the post-intervention period compared to the pre-intervention period (Pre: 39 min [IQR; 30-50] vs. Post: 29 min [IQR; 22-31]; P=0.007, Pre: 76 min [IQR; 58-87] vs. Post: 59 min [IQR; 44-68]; P=0.02, respectively). The 30-day mortality was similar between the two periods (Pre: 88% vs. Post: 80%; P=0.6). In contrast, the rate of favorable neurological outcome at the time of discharge was significantly higher in post-intervention period (Pre: 0% vs. Post: 20%; P=0.01) compared to the pre-intervention period. Conclusion: A comprehensive simulation-based training for E-CPR seems to improve the neurological outcome in patients with refractory OHCA patients.

The relationship between no-flow interval and survival with favourable neurological outcome in out-of-hospital cardiac arrest: Implications for outcomes and ECPR eligibility

Resuscitation ◽  
2020 ◽  
Vol 155 ◽  
pp. 219-225 ◽  
Author(s):  
Andrew Guy ◽  
Takahisa Kawano ◽  
Floyd Besserer ◽  
Frank Scheuermeyer ◽  
Hussein D. Kanji ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
The Relationship ◽  
Hospital Cardiac Arrest

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.

Sign in / Sign up

Export Citation Format

Share Document