Abstract 26: Evaluating Variation in Return of Spontaneous Circulation Rates Across EMS Agencies in Michigan

Background: Out-of-hospital cardiac arrest (OHCA) outcomes vary significantly across U.S. communities; however, systems of care factors that increase the likelihood of survival have not been well elucidated. The Enhancing Pre-Hospital Outcomes for Cardiac Arrest (EPOC) study is quantifying variation in the rate of sustained return of spontaneous circulation (ROSC) upon ED arrival across Michigan EMS agencies as a first step to identifying ‘best practices’ in prehospital OHCA care. Methods: Michigan Cardiac Arrest Registry to Enhance Survival (CARES) data for the years 2014-2016 was used. EMS agencies with 5+ arrests over the study years were included in the analysis. Using mixed-effects logistic regression, we calculated each agency’s reliability-adjusted sustained ROSC upon ED arrival; these rates were standardized across patient-, community-, and arrest-level characteristics. Results: A total of 91 agencies covering >6.8 million lives met inclusion criteria. We included 14,219 OHCA patients with a mean age of 62.6, 40.0% female, and 18.2% with a shockable rhythm in the analyses. Across all agencies, the mean patient-standardized rate of sustained ROSC with pulse upon ED arrival was 25.3% (range, 6.1%-51.9%; IQR range, 18.9%-31.2%) ( Figure 1 ). There were 14 agencies with patient-standardized rates and 95% CIs that exceeded the overall mean survival rate suggesting better-than-average outcomes while 16 agencies had rates and 95% CIs that were lower than the overall mean survival rate. Conclusion: We found more than 8-fold variation in OHCA survival rates across EMS agencies in Michigan, suggesting large differences in the effectiveness of prehospital systems of care. Future qualitative work will seek to identify ‘best practices’ by further determining the role of key factors such as tele-dispatch CPR, EMS agencies, fire, and police within high performing systems.

Download Full-text

Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

Health & Research Journal ◽

10.12681/healthresj.20871 ◽

2019 ◽

Vol 5 (2) ◽

pp. 53

Author(s):

Styliani Papadopoulou ◽

Olympia Konstantakopoulou ◽

Antonia Kalogianni ◽

Martha Kelesi-Stavropoulou ◽

Theodore Kapadohos

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Survival Rate ◽

Emergency Room ◽

Survival Rates ◽

Public Health Problem ◽

Spontaneous Circulation ◽

Shockable Rhythm ◽

Discharged Patients ◽

Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

Download Full-text

Improving Survival After In-Hospital Cardiac Arrest: The Australian Experience

American Journal of Critical Care ◽

10.4037/ajcc2007.16.3.240 ◽

2007 ◽

Vol 16 (3) ◽

pp. 240-247 ◽

Cited By ~ 32

Author(s):

Robyn Peters ◽

Mary Boyde

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Survival Rates ◽

Spontaneous Circulation ◽

High Rate ◽

Hospital Data ◽

Return Of Spontaneous Circulation ◽

Shockable Rhythm ◽

Resuscitation Training ◽

Hospital Cardiac Arrest

Background Survival rates after in-hospital cardiac arrest have not improved markedly despite improvements in technology and resuscitation training. Objectives To investigate clinical variables that influence return of spontaneous circulation and survival to discharge after in-hospital cardiac arrest. Methods An Utstein-style resuscitation template was implemented in a 750-bed hospital. Data on 158 events were collected from January 2004 through November 2004. Significant variables were analyzed by using a multiple logistic regression model. Results Of the 158 events, 128 were confirmed cardiac arrests. Return of spontaneous circulation occurred in 69 cases (54%), and the patient survived to discharge in 41 (32%). An initial shockable rhythm was present in 42 cases (33%), with a return of spontaneous circulation in 32 (76%) and survival to discharge in 24 (57%). An initial nonshockable rhythm was present in the remaining 86 cases (67%), with a return of spontaneous circulation in 37 (43%) and survival to discharge in 17 (20%). Witnessed or monitored arrests (P=.006), time to arrival of the cardiac arrest team (P=.002), afternoon shift (P=.02), and initial shockable rhythm (P=.005) were independently associated with return of spontaneous circulation. Location of patient in a critical care area (P=.002), initial shockable rhythm (P<.001), and length of resuscitation (P=.02) were independently associated with survival to hospital discharge. Conclusions The high rate of survival to discharge after cardiac arrest is attributed to extensive education and the incorporation of semiautomatic external defibrillators into basic life support management.

Download Full-text

Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: An observational cohort study

Resuscitation ◽

10.1016/j.resuscitation.2014.07.011 ◽

2014 ◽

Vol 85 (11) ◽

pp. 1488-1493 ◽

Cited By ~ 44

Author(s):

Ian R. Drennan ◽

Steve Lin ◽

Daniel E. Sidalak ◽

Laurie J. Morrison

Keyword(s):

Cardiac Arrest ◽

Cohort Study ◽

Survival Rates ◽

Spontaneous Circulation ◽

Observational Cohort Study ◽

Return Of Spontaneous Circulation ◽

Observational Cohort ◽

Hospital Cardiac Arrest

Download Full-text

Utility of opening rhythms in predicting time to return of spontaneous circulation in cardiac arrest victims in a resource constrained setting: a single centre prospective observational study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195543 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4709

Author(s):

Appu Suseel ◽

Siju V. Abraham ◽

Radha K. R.

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Cardiopulmonary Arrest ◽

Spontaneous Circulation ◽

Secondary Outcome ◽

Resource Constrained ◽

Return Of Spontaneous Circulation ◽

Shockable Rhythm ◽

Significant Difference ◽

Mean Time

Background: Time to ROSC has been shown to be an important and independent predictor of mortality and adverse neurological outcome. In resource limited situations judicious deployment of resources is crucial. Prognostication of arrest victims may aid in better resource allocation. This study aimed to assess the time to Return of Spontaneous Circulation (ROSC) in cardiac arrest victims and its relationship with opening rhythms.Methods: Consecutive victims of cardiopulmonary arrest who presented to a single center were included in this study if they met the inclusion and exclusion criteria. Time at which opening rhythm was analyzed and time at which ROSC was achieved was noted. This was done for all cases and mean time to ROSC was calculated for each opening rhythm. All those patients who achieved ROSC were followed up till hospital discharge or death. Primary outcome measured was achievement of ROSC and the secondary outcome was the survival to hospital discharge.Results: A sample size of 100 was calculated to yield a significance criterion of 0.05 and a power of 0.80 based on prior studies. Out of 100 patients studied. 58% had shockable rhythms and 42% had non-shockable rhythms. Mean time to ROSC for shockable rhythm was 5.55±3.51 minutes, and for non-shockable rhythm is 17.29±4.18 minutes. There was a statistically significant difference between opening rhythms in terms of survival to hospital discharge (p=0.0329).Conclusions: Cardiac arrests with shockable rhythms attained ROSC faster when compared to nonshockable rhythms. Shockable rhythms have a better survival to hospital discharge when compared to shockable rhythms. Opening rhythms may aid the clinician in better utility of resources in a resource constrained setting.

Download Full-text

Survival and long-term outcomes following in-hospital cardiac arrest in a Swiss university hospital: a prospective observational study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00931-0 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Alexander Fuchs ◽

Dominic Käser ◽

Lorenz Theiler ◽

Robert Greif ◽

Jürgen Knapp ◽

...

Keyword(s):

Cardiac Arrest ◽

Functional Status ◽

Survival Rates ◽

Spontaneous Circulation ◽

University Hospital ◽

Return Of Spontaneous Circulation ◽

Life Threatening ◽

Team Interventions ◽

Hospital Cardiac Arrest ◽

Cardiac Arrest Team

Abstract Background Incidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21–30%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests in the hospital are unknown. Our aim was to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests. Methods We conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days, after 1 and 5 years), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey. Results The cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ± 13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived the first year lived also to 5 years after the event with favourable neurological and functional status. Conclusions The in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1000 patient admissions. After a cardiac arrest, about a third of the patients survived to 5 years with favourable neurological and functional status. Alarms unrelated to life-threatening situations are common and need to be taken into count within a low-threshold alarming system. Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).

Download Full-text

Survival and Long-term Outcomes Following in-hospital Cardiac Arrest in a Swiss University Hospital: a Prospective Observational Study

10.21203/rs.3.rs-329760/v1 ◽

2021 ◽

Author(s):

Alexander Fuchs ◽

Dominic Käser ◽

Lorenz Theiler ◽

Robert Greif ◽

Jürgen Knapp ◽

...

Keyword(s):

Cardiac Arrest ◽

Functional Status ◽

Survival Rates ◽

Neurological Status ◽

Spontaneous Circulation ◽

University Hospital ◽

Return Of Spontaneous Circulation ◽

Team Interventions ◽

Hospital Cardiac Arrest ◽

Cardiac Arrest Team

Abstract Background: Incidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team from the Department of Anaesthesiology and Pain Medicine that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests are unknown. The aim was thus to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests.Methods: We conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days and 1 year), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey.Results: The cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ±13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived to 1 year after the event showed favourable neurological and functional status. Conclusions: The in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1,000 patient admissions. After a cardiac arrest, about a third of the patients survived to 1 year with favourable neurological and functional status. Early recognition and high-quality cardiopulmonary resuscitation provided by a well-organised team is crucial for patient survival.Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).

Download Full-text

Mechanical Versus Manual Chest Compression: A Retrospective-Cohort in Out-of-Hospital Cardiac Arrest

Acta Medica ◽

10.32552/2021.actamedica.657 ◽

2021 ◽

pp. 1-7

Author(s):

Alp Şener ◽

Gül Pamukçu Günaydın ◽

Fatih Tanrıverdi

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Survival Rates ◽

Spontaneous Circulation ◽

Retrospective Case ◽

Return Of Spontaneous Circulation ◽

Mechanical Chest Compression ◽

Manual Chest Compression ◽

Hospital Cardiac Arrest

Objective: In cardiac arrest cases, high quality cardiopulmonary resuscitation and effective chest compression are vital issues in improving survival with good neurological outcomes. In this study, we investigated the effect of mechanical chest compression devices on 30- day survival in out-of-hospital cardiac arrest. Materials and Methods: This retrospective case-control study was performed on patients who were over 18 years of age and admitted to the emergency department for cardiac arrest between January 1, 2016 and January 15, 2018. Manual chest compression was performed to the patients before January 15, 2017, and mechanical chest compression was performed after this date. Return of spontaneous circulation, hospital discharge, and 30-day survival rates were compared between the groups of patients in terms of chest compression type. In this study, the LUCAS-2 model piston-based mechanical chest compression device was used for mechanical chest compressions. Results: The rate of return of spontaneous circulation was significantly lower in the mechanical chest compression group (11.1% vs 33.1%; p < 0.001). The 30-day survival rate was higher in the manual chest compression group (6.8% vs 3.7%); however, this difference was not statistically significant (p = 0.542). Furthermore, 30-day survival was 0% in the trauma group and 0.6% in the patient group who underwent cardiopulmonary resuscitation for over 20 minutes. Conclusion: It can be seen that the effect of mechanical chest compression on survival is controversial; studies on this issue should continue and, furthermore, studies on the contribution of mechanical chest compression on labor loss should be conducted.

Download Full-text

Abstract 12258: Out-of-hospital Cardiac Arrest With Initially Shockable Rhythm: What Are the Outcomes if No Shock is Given?

Circulation ◽

10.1161/circ.132.suppl_3.12258 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yan Xiong ◽

Ahamed H Idris

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Spontaneous Circulation ◽

Shock Delivery ◽

Return Of Spontaneous Circulation ◽

Shockable Rhythm ◽

Multiple Variable ◽

Multiple Variable Regression ◽

Hospital Cardiac Arrest ◽

Resuscitation Attempt

Background: Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with a shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. Objectives: To describe demographics, pre-hospital characteristics, interventions, and outcomes in OHCA patients with an initially shockable rhythm who did and did not get shocked in the field in DFW ROC site. Methods: We included all non-traumatic OHCA cases ≥18 years old with VF or VT as first known rhythms, who were treated and transported to a hospital within the DFW ROC site between 2006 - 2011. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multiple variable regression analysis assessed the association between shock delivery and ROSC in the field as well as survival. Results: Included were 882 adult non-traumatic OHCA cases with VF or VT as first known rhythms; mean (±SD) age was 60 ± 15 years, 71% male, bystander witnessed 56%, bystander resuscitation attempt 43%, public arrest location 26%, EMS response time 4.7 ± 2.3 min, 26.9% (237) had ROSC in the field, 14.9% (131) survived to hospital discharge; 93.4% (824) of all patients were shocked, while 6.6% (58) were not shocked. Of the 6.6% (58) who were not shocked, 12.1% (7) achieved ROSC in the field and 8.6% (5) survived to hospital discharge. For those not shocked in the field, the unadjusted and adjusted odds ratios for ROSC were 0.354 (95% CI 0.158-0.791, p=0.011) and 0.189 (95% CI 0.039-0.911, p=0.038), respectively; and for survival to hospital discharge they were 0.522 (95% CI 0.205-1.331, p=0.173) and 0.498 (95% CI 0.088-2.810, p=0.430), respectively. Conclusions: In the DFW ROC site, 6.6% of OHCA victims with an initially shockable rhythm did not receive a shock, which was significantly associated with decreased ROSC in the field. More patients survived who were shocked in the field, but this difference was not significant after adjustment for Utstein variables.

Download Full-text

Assessment of changes in cardiopulmonary resuscitation practices and outcomes on 1005 victims of out-of-hospital cardiac arrest during the COVID-19 outbreak: registry-based study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00813-x ◽

2020 ◽

Vol 28 (1) ◽

Author(s):

Valentine Baert ◽

◽

Deborah Jaeger ◽

Hervé Hubert ◽

Jean-Baptiste Lascarrou ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Survival Rates ◽

First Aid ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Percentage Points ◽

Medical Teams ◽

Hospital Cardiac Arrest

Abstract Background The COVID-19 outbreak requires a permanent adaptation of practices. Cardiopulmonary resuscitation (CPR) is also involved and we evaluated these changes in the management of out-of-hospital cardiac arrest (OHCA). Methods OHCA of medical origins identified from the French National Cardiac Arrest Registry between March 1st and April 31st 2020 (COVID-19 period), were analysed. Different resuscitation characteristics were compared with the same period from the previous year (non-COVID-19 period). Results Overall, 1005 OHCA during the COVID-19 period and 1620 during the non-COVID-19 period were compared. During the COVID-19 period, bystanders and first aid providers initiated CPR less frequently (49.8% versus 54.9%; difference, − 5.1 percentage points [95% CI, − 9.1 to − 1.2]; and 84.3% vs. 88.7%; difference, − 4.4 percentage points [95% CI, − 7.1 to − 1.6]; respectively) as did mobile medical teams (67.3% vs. 75.0%; difference, − 7.7 percentage points [95% CI, − 11.3 to − 4.1]). First aid providers used defibrillators less often (66.0% vs. 74.1%; difference, − 8.2 percentage points [95% CI, − 11.8 to − 4.6]). Return of spontaneous circulation (ROSC) and D30 survival were lower during the COVID-19 period (19.5% vs. 25.3%; difference, − 5.8 percentage points [95% CI, − 9.0 to − 2.5]; and 2.8% vs. 6.4%; difference, − 3.6 percentage points [95% CI, − 5.2 to − 1.9]; respectively). Conclusions During the COVID-19 period, we observed a decrease in CPR initiation regardless of whether patients were suspected of SARS-CoV-2 infection or not. In the current atmosphere, it is important to communicate good resuscitation practices to avoid drastic and lasting reductions in survival rates after an OHCA.

Download Full-text

Abstract 206: Cardiopulmonary Resuscitation Process Measures Associated With Return of Spontaneous Circulation in Non-Shockable Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.206 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Jose M Juarez ◽

Allison C Koller ◽

Robert H Schmicker ◽

Seo Young Park ◽

David D Salcido ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Duty Cycle ◽

Spontaneous Circulation ◽

Research Network ◽

Process Measures ◽

Return Of Spontaneous Circulation ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Purpose: Survival rates after non-shockable out-of-hospital cardiac arrest (OHCA) remain low despite advances in resuscitation. Cardiopulmonary resuscitation (CPR) process measures may inform treatment strategies. We hypothesized that CPR process measures would be associated with return of spontaneous circulation (ROSC) and patient electrocardiogram (ECG) transitions. Methods: We obtained defibrillator monitor data for emergency medical service (EMS)-treated non-shockable OHCA from the Resuscitation Outcomes Consortium (ROC), an OHCA research network (U.S./Canada). We extracted ECG data from EMS defibrillator files and parsed cases into compression-free analyzable segments using custom MATLAB software. Two data abstractors classified segment rhythms as PEA, asystole, ventricular fibrillation (VF), pulseless ventricular tachycardia (PVT), or ROSC. We calculated CPR process measures (average rate, depth, duration, leaning proportion, chest compression fraction, and duty cycle) for CPR bouts preceding every ECG segment. We used mixed effects models controlling for subject to test associations between individual CPR process measures and the bout-level outcomes ROSC and shockable rhythm. Results: We analyzed 1893 cases consisting of 7981 CPR bouts. Case initial rhythms were asystole (68.2%), PEA (24.9%), or NSA-AED (6.9%). Segment rhythm classifications were asystole (78.1%), PEA (20.4%), ROSC (5.5%), VF (1.4%), and PVT (0.07%). Regression model results are shown in Table 1. Chest compression fraction was most strongly associated with ROSC and shockable rhythm. Depth was also associated with shockable rhythm. Leaning proportion and duty cycle were not associated with either outcome. Conclusions: In cases of non-shockable OHCA, CPR quality measures were associated with ROSC and transition to a shockable rhythm at the bout level.

Download Full-text