Abstract 355: Performance of Inclusion and Exclusion Criteria Based on Prognosis in an Interventional Out-of-Hospital Cardiac Arrest Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Nick Krehel ◽  
Clifton W Callaway ◽  
Ankur Doshi ◽  
Jonathan Elmer ◽  
Francis X Guyette ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Poor Prognosis ◽  
Tertiary Care ◽  
Good Prognosis ◽  
Spontaneous Circulation ◽  
Relative Paucity ◽  
Poor Outcomes ◽  
Cardiac Arrest Study ◽  
Tertiary Care Centers ◽  
Hospital Cardiac Arrest

Introduction: Selection of out-of-hospital cardiac arrest (OHCA) patients for inclusion in randomized control trials (RCT) presents a challenge. The goal is to enroll patients with severe injury warranting intervention yet exclude those with extreme irreversible disease. Selection early after return of spontaneous circulation (ROSC) is complicated by a relative paucity of prognostic variables. We examined the accuracy of enrollment criteria in the iNO OHCA study (NCT03079102) in excluding patients likely to have good or poor outcomes within three hours (3h) of ROSC. Methods: OHCA patients arriving to two tertiary care centers in Pittsburgh were screened within 3h of ROSC. We excluded subjects that followed commands (good prognosis expected) and subjects expected to have poor prognosis based on: Full Outline of UnResponsiveness Brainstem (FOUR B) score <2; CPR time >40 min; investigator estimate of >95% mortality; CT evidence of cerebral edema or intracranial hemorrhage; clinical evidence of myoclonic status epilepticus; or traumatic OHCA etiology. We also excluded subjects not within 3h of ROSC. We compared discharge survival and good neurologic outcome based on disposition (location). Results: Over a nine-month period we screened 155 patients with ROSC following OHCA, 20 subjects (13%) were included in the study and 135 (87%) were excluded ( Table ). The odds ratio (OR) of survival if excluded for poor prognosis was 0.03 (95% CI: 0.01 - 0.08) and worsened when >1 criteria were met. Exclusion for good prognosis was associated with improved survival (OR = 67.2 [95% CI: 14.3 - 316.3]). Conclusions: Our criteria reliably exclude OHCA subjects with good or poor prognosis within 3h of ROSC, yielding a study population with intermediate survival which can be applicable to future OHCA trials. Our criteria selected a minority (13%) of OHCA patients likely to benefit from intervention while reserving resources.

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

scholarly journals Just the Facts: Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 760-763
Author(s):  
Shannon M. Fernando ◽  
Brian Grunau ◽  
Daniel Brodie
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Tertiary Care ◽  
Spontaneous Circulation ◽  
Tertiary Care Centre ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
St Segment Elevation ◽  
St Segment ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

A 58-year-old man is brought by the ambulance to the emergency department (ED) of a tertiary care centre following an out-of-hospital cardiac arrest. Paramedics were called by the patient's wife after he had collapsed. She immediately initiated cardiopulmonary resuscitation (CPR). Prior to his collapse, he had been complaining of chest pain. His initial rhythm in the field was ventricular fibrillation, and he received defibrillation. An automated CPR device was applied prior to transport. En route, return of spontaneous circulation is achieved. An electrocardiogram shows ST-segment elevation in the anterior leads. Just prior to arrival, the patient suffers recurrent cardiac arrest with two further rounds of unsuccessful defibrillation in the ED. At this point, a decision is made to proceed with extracorporeal cardiopulmonary resuscitation (ECPR), prior to transport for cardiac catheterization.

Abstract 189: Time to Awakening in Women Compared to Men After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sarah M Perman ◽  
Shelby Shelton ◽  
Stacie L Daugherty ◽  
Edward Havranek
Keyword(s):  
Cardiac Arrest ◽  
Tertiary Care ◽  
Spontaneous Circulation ◽  
Therapeutic Interventions ◽  
Care Hospital ◽  
Single Center ◽  
Men And Women ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Background: Previous studies have shown that comatose survivors of cardiac arrest awaken approximately 3 days after return of spontaneous circulation (ROSC) however, variability in time to awakening is frequently observed. Recent data has shown that women metabolize drugs (sedatives and paralytics) differently than men. It is unknown if there are sex based differences in time to awakening for comatose survivors of cardiac arrest, and if this phenomenon might be affected by differences in withdrawal of life sustaining therapy (WLST). Objective: To determine if comatose women have different times to awakening after resuscitation from cardiac arrest. Methods: We analyzed 327 consecutive charts from a single center registry of all out of hospital cardiac arrest patients who had return of spontaneous circulation but remained comatose, cared for at an urban academic tertiary care hospital. Patient demographic and arrest characteristics were abstracted. We identified day of awakening for comatose survivors by abstracting day when Glasgow coma motor score was 6 as documented in nursing flowsheets. Time to withdrawal of life sustaining therapy was also abstracted for the cohort that did not awaken. Patients were excluded from analysis if they did not awaken or if they died for reasons other than WLST. Results: Twenty-eight percent of patients woke prior to hospital discharge and 43.4% underwent withdrawal of life sustaining therapy. Women made up 39.5% of the total cohort, 40% of the awakened cohort and 41% of the WLST cohort. Women had earlier day of awakening in comparison to men (day 2 (2, 4) vs. day 4 (2,5), p=0.0036), and also earlier time to WLST after ROSC than men (59 hours (26, 131) vs. 64 hours (22, 135), p=NS). Conclusion: In this single center cohort, there was a difference in time to awakening between men and women. How time to awakening might differ between the sexes with guideline concordant time to WLST is unknown. Further research is necessary to explore the role of therapeutic interventions and differing physiology between men and women as it applies to time to awakening.

Abstract 375: Utility of Routine Early Head Computed Tomography Following Non-Traumatic Out-Of Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Bradley J Petek ◽  
David E Hamilton ◽  
Lindsay G Panah ◽  
Philip E Dormish ◽  
Sean R Mendez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Clinical Utility ◽  
Spontaneous Circulation ◽  
Head Ct ◽  
Shockable Rhythm ◽  
Baseline Characteristics ◽  
Poor Outcomes ◽  
Head Computed Tomography ◽  
Hospital Cardiac Arrest

Introduction: Head computed tomography (CT) is frequently performed in survivors of out-of-hospital cardiac arrest (OHCA). However, the clinical utility of routine, early head CT in these patients is not well understood. We sought to characterize the associations between findings on early head CT with presenting characteristics and outcomes in survivors of OHCA. Hypothesis: Presence of early intracranial swelling is associated with poor outcomes. Methods: This is a retrospective analysis from a multicenter cohort of 432 patients with non-traumatic OHCA between 2/1/17 through 4/1/19. Patients were included if they underwent head CT <24 hrs after return of spontaneous circulation. Head CT findings were based on reads performed by local radiologists. Intracranial swelling was defined as loss of gray-white matter differentiation, sulcal effacement, and/or cerebral edema. Underlying cause of OHCA was adjudicated by trained physicians. Baseline characteristics and outcomes were compared between those with and without intracranial swelling. Result: Early head CT (<24 hrs) was performed in 378 (87.5%) patients with OHCA. Intracranial swelling was present in 97 (25.7%) patients with early head CT, and 14 (3.7%) had evidence of intracranial hemorrhage (ICH, Table). Of the patients presenting with ICH, 3/14 (21.4%) had shockable rhythms, 7/14 (50%) had subarachnoid hemorrhage, and ICH was the adjudicated cause of arrest in 10/14 (71.4%) patients. Patients with intracranial swelling were younger, less likely to have presented with a shockable rhythm, cardiac etiology, and witnessed OHCA. They were more likely to have a suppressed EEG, anoxia on MRI, and were less likely to survive to hospital discharge. Conclusions: In survivors of non-traumatic OHCA, routine, early (<24 hrs) head CT identified ICH in 3.7% of patients, and ICH was the adjudicated cause of arrest in 2.6% of patients. Intracranial swelling was present in more than 1/4 of patients, and associated with poor outcomes.

scholarly journals Effect of preceding medications on resuscitation outcome of out-of-hospital cardiac arrest

2016 ◽  
Vol 65 (3) ◽  
pp. 689-693 ◽  
Author(s):  
Shih-Wen Hung ◽  
Chien-Ming Chu ◽  
Chih-Feng Su ◽  
Li-Ming Tseng ◽  
Tzong-Luen Wang
Keyword(s):  
Cardiac Arrest ◽  
Prehospital Care ◽  
Tertiary Care ◽  
Potential Effect ◽  
Spontaneous Circulation ◽  
Care Hospital ◽  
Favorable Neurological Outcome ◽  
Continuous Use ◽  
The Impact ◽  
Hospital Cardiac Arrest

As evidence regarding the impact of preceding medications on resuscitation outcomes has been inconsistent, this study aimed to analyze the association between preceding medications and resuscitation outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA). This retrospective study included patients with OHCA presenting to a tertiary care hospital by emergency medical service (EMS) between January 2006 and June 2011. Using the Utstein template, data were collected from EMS and hospital medical records for prehospital care, in-hospital care, and medications which were taken continuously for at least 2 weeks preceding OHCA. Primary outcome was the proportion of patients with a survived event. Multivariable logistic regression analyses were performed to evaluate the predictors of survived events. Among the 1381 included patients with OHCA, 552 (40.0%) patients achieved sustained return of spontaneous circulation and 463 (33.5%) patients survived after resuscitation, 96 (7.0%) patients survived until discharge, and 20 (1.4%) patients had a favorable neurological outcome at discharge. The multivariable analyses revealed that use of statins preceding OHCA was independently associated with a greater probability of a survived events (OR=2.09, 95% CI 1.08 to 4.03, p=0.028).Use of digoxin was adversely associated with survived events (OR=0.39, 95% CI 0.16 to 0.90, p=0.028) in patients with OHCA. The continuous use of statins preceding OHCA was positively associated with survived events, while use of digoxin was adversely related. It deserves more attention on medications preceding OHCA because of their potential effect on resuscitation outcomes.

scholarly journals Comparison of two strategies for managing in-hospital cardiac arrest

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jafer Haschemi ◽  
Ralf Erkens ◽  
Robert Orzech ◽  
Jean Marc Haurand ◽  
Christian Jung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Life Support ◽  
Group Versus ◽  
Advanced Cardiac Life Support ◽  
Spontaneous Circulation ◽  
Neurological Outcomes ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest ◽  
Cardiac Arrest Team

AbstractIn-hospital cardiac arrest (IHCA) is associated with poor outcomes. There are currently no standards for cardiac arrest teams in terms of member composition and task allocation. Here we aimed to compare two different cardiac arrest team concepts to cover IHCA management in terms of survival and neurological outcomes. This prospective study enrolled 412 patients with IHCA from general medical wards. From May 2014 to April 2016, 228 patients were directly transferred to the intensive care unit (ICU) for ongoing resuscitation. In the ICU, resuscitation was extended to advanced cardiac life support (ACLS) (Load-and-Go [LaG] group). By May 2016, a dedicated cardiac arrest team provided by the ICU provided ACLS in the ward. After return of spontaneous circulation (ROSC), the patients (n = 184) were transferred to the ICU (Stay-and-Treat [SaT] group). Overall, baseline characteristics, aetiologies, and characteristics of cardiac arrest were similar between groups. The time to endotracheal intubation was longer in the LaG group than in the SaT group (6 [5, 8] min versus 4 [2, 5] min, p = 0.001). In the LaG group, 96% of the patients were transferred to the ICU regardless of ROSC achievement. In the SaT group, 83% of patients were transferred to the ICU (p = 0.001). Survival to discharge did not differ between the LaG (33%) and the SaT (35%) groups (p = 0.758). Ultimately, 22% of patients in the LaG group versus 21% in the SaT group were discharged with good neurological outcomes (p = 0.857). In conclusion, we demonstrated that the cardiac arrest team concepts for the management of IHCA did not differ in terms of survival and neurological outcomes. However, a dedicated (intensive care) cardiac arrest team could take some load off the ICU.

Abstract 75: Ventricular Fibrillation in Cardiac Arrest with Nonshockable Initial Rhythm

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fernando Rosell-Ortiz ◽  
Francisco J Mellado-Vergel ◽  
Patricia Fernández-Valle ◽  
Auxiliadora Caballero-García ◽  
Ismael González-Lobato ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Neurological Status ◽  
Good Prognosis ◽  
Spontaneous Circulation ◽  
Emergency Team ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Prognostic Group ◽  
Hospital Cardiac Arrest

The initial shockable rhythm in cardiac arrest is a well known factor of good prognosis. Little is known about the influence of the onset of ventricular fibrillation during resuscitation at cardiac arrest whose initial rhythm was non-shockable. Methods: Retrospective analysis of a continuous registry of out-of-hospital cardiac arrest (OHCA) Inclusion criteria, all consecutive patients suffering OHCA attended by emergency teams in Andalusia, Spain. Period January 2008 - December 2012. Results: 5067 patients were included. According to the initial cardiac arrest rhythm 1038 (20.5%) cases presented initial shockable rhythm (SR) and 4029 (79.5%) with non-shockable initial rhythm (NSR). Of these patients 150 (3%) reported one or more episodes of ventricular fibrillation during resuscitation (NSRVF). The main clinical characteristics of these three groups are shown in Table 1. Variables associated with good neurological status at hospital discharge are shown in Table 2. Conclusions: NSRVF patients present higher survival with good neurological status than NSR patients. These patients may represent a third prognostic group in cardiac arrest with a survival rate between shockable and non-shockable initial rhythms. Table 1. Clinical data of patients regarding rhythm of cardiac arrest Table 2. Variables associated with good neurological status at discharge (CPC 1-2 ) SD: Standard deviation. IQR: Interquartile range. OR: Odds Ratio. CI: Confidence Interval. ET: Emergency Team. VF: Ventricular Fibrillation. CPR: Cardiopulmonary resuscitation. CPC: Cerebral Perfomance Category. ROSC: Return of spontaneous circulation

scholarly journals Early lactate and glucose kinetics following return to spontaneous circulation after out-of-hospital cardiac arrest

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Pedro Freire Jorge ◽  
Rohan Boer ◽  
Rene A. Posma ◽  
Katharina C. Harms ◽  
Bart Hiemstra ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Physiological Stress ◽  
Spontaneous Circulation ◽  
Strenuous Exercise ◽  
Rapid Rate ◽  
Glucose Kinetics ◽  
Initial Value ◽  
Extreme Stress ◽  
Arterial Ph ◽  
Hospital Cardiac Arrest

Abstract Objective Lactate has been shown to be preferentially metabolized in comparison to glucose after physiological stress, such as strenuous exercise. Derangements of lactate and glucose are common after out-of-hospital cardiac arrest (OHCA). Therefore, we hypothesized that lactate decreases faster than glucose after return-to-spontaneous-circulation (ROSC) after OHCA. Results We included 155 OHCA patients in our analysis. Within the first 8 h of presentation to the emergency department, 843 lactates and 1019 glucoses were available, respectively. Lactate decreased to 50% of its initial value within 1.5 h (95% CI [0.2–3.6 h]), while glucose halved within 5.6 h (95% CI [5.4–5.7 h]). Also, in the first 8 h after presentation lactate decreases more than glucose in relation to their initial values (lactate 72.6% vs glucose 52.1%). In patients with marked hyperlactatemia after OHCA, lactate decreased expediently while glucose recovered more slowly, whereas arterial pH recovered at a similar rapid rate as lactate. Hospital non-survivors (N = 82) had a slower recovery of lactate (P = 0.002) than survivors (N = 82). The preferential clearance of lactate underscores its role as a prime energy substrate, when available, during recovery from extreme stress.

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

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