Abstract 308: Pupil Diameter Predicts the Outcome in Patients With Cardiopulmonary Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shunichi Imamura ◽  
Masaaki Miyata ◽  
Risa Kamata ◽  
Yutaro Nomoto ◽  
Issei Yoshimoto ◽  
...  
Keyword(s):  
Area Under Curve ◽  
Operating Characteristic ◽  
Pupil Diameter ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Optimal Management ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
The Mean ◽  
Age And Sex

Introduction: Early prediction of the outcome in patients with cardiopulmonary arrest (CPA) is important to select the optimal management. The pupil diameter is a simple neurological examination and it predicts the prognosis in patient with stroke. However, the clinical significance of pupil diameter in CPA has not been elucidated. Hypothesis: We hypothesized that pupil diameter would predict the prognosis of CPA patients. Methods: We retrospectively analyzed consecutive 45 patients with CPA and return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation in our hospital. We analyzed age, sex, cause of CPA, time during CPA, pupil diameter at admission and death in hospital. Results: The mean of age was 67±20 years and male were 34 (76%). The median of CPA time was 33 min [25%, 75%; 22, 46] and pupil diameter was 4.8 mm [3.0, 6.0]. The 26 (58%) patients died in hospital after ROSC. There was no significant difference in age and sex between survival (n=19) and dead (n=26). The CPA time was significantly shorter in survival than that in dead (21 min [10, 39] vs 30 min [30, 52], p=0.005). Furthermore, pupil diameter was significantly smaller in survival compared with dead (3.0mm [2.5, 4.3] vs 5.0mm [4.4, 6.0]) (Figure). The receiver-operating characteristic (ROC) curve for survival after ROSC demonstrated that the area under curve was 0.73 and provided an optimal cut-off value at 4.0mm in pupil diameter with 75% sensitivity and 75% specificity. When CPA time was 28 minutes, the area under curve was 0.76, and sensitivity and specificity were 78% and 71%, respectively. Conclusion: As same as CPA time, pupil diameter is suggested to predict the outcome after ROSC in CPA patients.

scholarly journals The significance of strong ion gap for predicting return of spontaneous circulation in patients with cardiopulmonary arrest

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 33-38
Author(s):  
Minoru Kaneko ◽  
Shuichi Hagiwara ◽  
Makoto Aoki ◽  
Masato Murata ◽  
Jun Nakajima ◽  
...  
Keyword(s):  
Emergency Department ◽  
Operating Characteristic ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Anion Gap ◽  
Strong Ion Gap ◽  
Return Of Spontaneous Circulation ◽  
Receiver Operating Characteristic Curves ◽  
Significant Difference ◽  
The Difference

AbstractUseful parameters that can predict return of spontaneous circulation (ROSC) in patients with cardiopulmonary arrest (CPA) have not been established. We previously reported the usefulness of anion gap (AG) and albumin-corrected anion gap (ACAG) calculated from a blood sample obtained on arrival at the hospital for the prediction of ROSC. Otherwise, it has been reported that strong ion gap (SIG), which shows the difference between the levels of fully dissociated cations and anions in the serum, is useful to predict the prognosis of critically ill patients.This was a prospective and observational clinical study. Patients with CPA transferred to the emergency department of our hospital between January 2013 and December 2014 were evaluated. Patients were divided into two groups: patients who obtained ROSC [ROSC(+) group] and those who did not [ROSC(−) group]. We compared AG, ACAG and SIG between the two groups.A total of 170 patients were enrolled. Fifty patients were included in the ROSC(+) group, and the remaining 120 in the ROSC(−) group. Both AG and ACAG were significantly better in the ROSC(+) group; however, there was no significant difference in SIG between the two groups. The area under the receiver operating characteristic curves (AUC) for ROSC of both AG and ACAG were almost the same (0.72 and 0.708, respectively); the AUC of SIG (0.57) was inferior to those of AG and ACAG.Our results suggest that AG and ACAG can better predict ROSC following cardiopulmonary resuscitation (CPR) compared with SIG.

scholarly journals 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

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.

scholarly journals Compare the Effects of Epinephrine and Vasopressin in Return of Spontaneous Circulation

2018 ◽  
Vol 6 (3) ◽  
pp. 7
Author(s):  
Samad Shams Vahdati ◽  
Azra Nejabatian ◽  
Farzad Rahmani ◽  
Paria Habibollahi ◽  
Pegah Sepehri Majd
Keyword(s):  
Cardiopulmonary Arrest ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
P Value ◽  
Coronary Perfusion ◽  
Results Of Treatment ◽  
Significant Difference ◽  
Rate Of Recovery ◽  
The Mean ◽  
Mean Time

Background: There is a conflict in the superiority of each of the vasopressin and epinephrine compared to the other. Vasopressin has a vasoconstrictive action that results in an increase of the coronary perfusion pressure. Due to the expensive and sometimes scarce of vasopressin in most hospitals, this study aims to evaluate the response rate of vasopressin compared with epinephrine, in return of ROSC. Methods: In this descriptive-analytical study all patients in the emergency medicine department were enrolled in the study suffered a cardiopulmonary arrest and resuscitation will be done instantly for them (According to the guidelines AHA 2010). Their data were extracted from the hospital records and the success rate of recovery, 3-month survival and complications in patients recovering from the drug used during the CPR were analyzed. Results: A total of 61 patients record were analyzed. 31 patients had received epinephrine alone and 30 patients received a combination of epinephrine and vasopressin. No significant difference was observed between the two groups in terms of sex, sepsis, hypovolemia, renal failure, cancers, drug toxicity, brady, dysrhythmia, PEA, VT, VF, defibrillator, duration of CPR and three month outcome. The mean time of CPR in combination of epinephrine and vasopressin group was 27.26±12.72 and the mean time of CPR in epinephrine group was 27.24±13.510 (p-value= 0.99).Conclusion: Among patients with in-hospital cardiopulmonary arrest in this study no statistically significant difference was obtained between the results of treatment with epinephrine alone and combination of epinephrine and vasopressin.

Abstract 15159: Differential Recovery Between Regional Cerebral Oxygen Saturation and Physiological Parameters in Cardiopulmonary Arrest Patients After Return of Spontaneous Circulation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Goro Tajima ◽  
Tadahiko Shiozaki ◽  
Yoshihito Ogawa ◽  
Tomoya Hirose ◽  
Nobuto Mori ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Cardiopulmonary Arrest ◽  
Arterial Oxygen Saturation ◽  
Spontaneous Circulation ◽  
Physiological Parameters ◽  
Arterial Oxygen ◽  
Return Of Spontaneous Circulation ◽  
Medical Centers ◽  
Emergency Medical ◽  
Significant Difference

Objective: We aimed to clarify the change in rSO2, blood pressure (BP) and arterial oxygen saturation (SpO2) in CPA patients who got return of spontaneous circulation (ROSC). Method: We measured rSO2 in CPA patients who were transferred to two tertiary emergency medical centers. On arrival, rSO2 sensor was attached to the forehead of patients, and monitored continuously during cardiopulmonary resuscitation. In the patients who got ROSC, we compared change in rSO2 and BP, SpO2, and evaluated the correlation between rSO2 and physiological parameters. Result: There were 79 CPA patients transferred to the tertiary emergency medical centers, and 38 patients got ROSC(Mean Age 74.8,M:F=25:13). rSO2 increased after ROSC, and showed the significance after 10 minutes after ROSC. Median rSO2 just after ROSC (ROSC 0) was 54.4% (47.2-59.5), and 66.0% (61.8-70.0) in 10 minutes after ROSC (ROSC 10) (Figure, p<0.01 ROSC 0 vs ROSC 10). However, in BP and SpO2, there were no significant difference between in ROSC 0 and ROSC 10. BP rather showed lower tendency in ROSC 10 compared to ROSC 0. BP; 97mmHg (82.0-127) vs 82.0mmHg (67.0-120), SpO2; 86.0% (70.8-95.0) vs 93.0% (76.0-98.3) Conclusion: We clarified that there is a delay in rSO2 recovery compared to BP, SpO2 recovery after ROSC in CPA patients. It might be a therapeutic point to correct the delay in rSO2 recovery.

Abstract 420: Comparison of Prognostic Predictors After Return of Spontaneous Circulation Between Cardiac and Non-Cardiac Cardiopulmonary Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kenta Ohmure ◽  
Masaaki Miyata ◽  
Kento Tagata ◽  
Tatsuo Yokomine ◽  
Yuutaro Nomoto ◽  
...  
Keyword(s):  
Creatinine Level ◽  
Roc Curve ◽  
Pupil Diameter ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Survival Group ◽  
Return Of Spontaneous Circulation ◽  
Prognostic Predictors ◽  
Arterial Blood ◽  
Kaplan Meier

Introduction: Understanding the characteristics of survivor after return of spontaneous circulation (ROSC) in patients with cardiopulmonary arrest (CPA) may help us to select the optimal management. Hypothesis: We hypothesized that the prognosis and predictors of survivor after ROSC could be different between cardiac and non-cardiac CPA patients. Method: We retrospectively analyzed consecutive 85 patients with CPA and ROSC after cardiopulmonary resuscitation (CPR) in our hospital and divided them into cardiogenic (n=35) and non-cardiogenic (n=50) CPA. We analyzed age, gender, bystander CPR, duration of CPA, pupil diameter at admission, Glasgow coma scale, total protein (TP) level, creatinine level, pH of arterial blood and death in hospital. Result: The 17 patients died in cardiogenic CPA and 40 patients in non-cardiogenic CPA. The Kaplan-Meier curve demonstrated the better prognosis in cardiogenic CPA compared with non-cardiogenic CPA (Figure). In both CPA, duration of CPA was shorter and total TP level was higher in survival than those in dead group. In cardiogenic CPA, age was younger and creatinine level was lower in survival group compared with dead group (Table). In non-cardiogenic CPA, pupil diameter was smaller in survival group compared with dead group. Furthermore, in TP levels, the receiver operating characteristic (ROC) curve for survival after ROSC demonstrated that the area under curve (AUC) was 0.82 and provided an optimal cut-off value at 6.2 mg/dl of TP with 71% sensitivity and 83% specificity. In non-cardiogenic CPA, ROC curve demonstrated that AUC was 0.73 and 59% sensitivity, and 100% specificity at the optimal cut-off value of TP 6.0 mg/dl. Therefore, TP levels may be the better prognostic predictor in cardiogenic CPA compared with non-cardiogenic CPA. Conclusion: Although duration of CPA and TP levels were common predictor for survival after ROSC in CPA, there were different prognostic predictors in cardiogenic or non-cardiogenic CPA.

Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shuichi Hagiwara ◽  
Kiyohiro Oshima ◽  
Masato Murata ◽  
Makoto Aoki ◽  
Kei Hayashida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Statistical Significance ◽  
Coronary Arteriography ◽  
Spontaneous Circulation ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Overall Performance ◽  
The Mean ◽  
Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

Abstract P141: Electrocardiogram Waveform Analysis Reveals Probability of Return of Spontaneous Circulation in Both Swine and Human Subjects

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lawrence D Sherman ◽  
James T Niemann ◽  
Thomas D Rea ◽  
John P Rosborough ◽  
James D Waters ◽  
...  
Keyword(s):  
Human Subjects ◽  
Area Under The Curve ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Waveform Analysis ◽  
Swine Model ◽  
Return Of Spontaneous Circulation ◽  
Percutaneous Balloon ◽  
Initial Shock ◽  
The Mean

Background: The Logarithm of the Absolute Correlations (LAC) is a measure which estimates VF duration based on the fractal dimension of the waveform. We hypothesized that the LAC measures the underlying physiology of the myocardium and would enable identification of those who would have return of spontaneous circulation (ROSC) in response to the initial shock. We tested this hypothesis in a swine model and among humans treated for out-of-hospital cardiac arrest Methods: 20 swine were placed in VF either by electrical stimulation (n=10) or through ischemia produced by percutaneous balloon occlusion of the left anterior descending artery (n=10). After 7 minutes of VF, CPR was performed for 1 min followed by defibrillation. Response to shock was recorded as ROSC if a BP of 60 mm Hg was present. The LAC was calculated for five second intervals during VF. In the human cohort, the AED ECG recordings of 165 subjects were analyzed. The average interval from 9 –1–1 call to EMS scene arrival was 5 minutes. Response to shock was recorded as ROSC if an organized rhythm corresponded with a palpable BP as determined by review of audio and written EMS report. The LAC was calculated on the 6 seconds of VF preceding the initial shock. In both the swine and human experience, we compared the mean LAC between those with and without ROSC. We calculated receiver operating characteristic (ROC) curves and measured the area under the curve to assess the diagnostic ability of the LAC. Results: In the swine model, the mean LAC differed significantly between swine with and without ROSC following the initial shock (with ROSC: 5.17±0.19 [n=6] versus without ROSC: 4.88±0.27 [n=14]: p = 0.033). The AUC for the LAC measure was 0.80. In the human cohort, the LAC also differed significantly between those with and without ROSC following the initial shock (5.21±0.34 [n=36] versus 4.81±0.47 [n=129], p < 0.0001). The AUC for the LAC measure was 0.76. Conclusions: The LAC measure predicts ROSC in both swine and human VF and can be used to guide resuscitation care. Swine ischemic VF is similar to that seen in humans.

End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 26 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Marc Eckstein ◽  
Lorien Hatch ◽  
Jennifer Malleck ◽  
Christian McClung ◽  
Sean O. Henderson
Keyword(s):  
Cardiac Arrest ◽  
Los Angeles ◽  
Spontaneous Circulation ◽  
Outcome Variable ◽  
Primary Outcome Variable ◽  
Return Of Spontaneous Circulation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Mean ◽  
End Tidal ◽  
Hospital Cardiac Arrest

AbstractObjective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

Clinical and pathological significance of sibling Graves' disease

1980 ◽  
Vol 94 (4) ◽  
pp. 498-502 ◽  
Author(s):  
Toshio Tanaka ◽  
Shoichi Katayama ◽  
Kanji Kuma ◽  
Hajime Tamai ◽  
Fumio Matsuzuka ◽  
...  
Keyword(s):  
Subtotal Thyroidectomy ◽  
Graves Disease ◽  
Lymphoid Follicles ◽  
Mean Values ◽  
Significant Difference ◽  
Thyroid Glands ◽  
History Of ◽  
The Mean ◽  
And Control ◽  
Age And Sex

Abstract. The clinical picture and serum antithyroid antibodies in 16 pairs of siblings with Graves' disease were compared with an age and sex matched group of 32 patients with Graves' disease who did not have a family history of any thyroid disease (control patients). There was a significant difference in frequency and mean titres of antibodies to thyroglobulin between sibling patients. (positive 76.0%) and control patients (positive 40.0%), but not in microsomal antibodies (sibling; positive 92.0%, control; 92.0%). There were no significant differences in the mean values of 24 h 131I-thyroidal uptake, serum T3U, serum T4 and T3 concentrations before treatment between the two groups. Lymphoid follicles and degeneration of the epithelia were more often found in the thyroid glands of sibling patients than in those of the control patients, when 32 (16 sibling, 16 control) thyroid glands from the same groups in the clinical study, including antibody series, were examined pathologically after subtotal thyroidectomy for Graves' disease. Moreover, there was a strong tendency to increased lymphocyte and plasma cell infiltration in the thyroid glands of sibling patients with Graves' disease. The findings might indicate that Graves' disease is closely related to Hashimoto's thyroiditis, especially in sibling patients with Graves' disease.

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