Abstract 109: Automated External Defibrillators Are Rarely Used for In-Hospital Cardiac Arrest in Denmark

Introduction: Automated External Defibrillators (AEDs) are widely distributed in the pre-hospital setting and reported to reduce time to defibrillation and increase survival from out-of-hospital cardiac arrest. During in-hospital cardiac arrest (IHCA), AEDs may allow for early defibrillation before the cardiac arrest team arrives with a manual defibrillator. However, the effect of AEDs for IHCA remains unclear. This study aimed to investigate AED usage and contribution to defibrillation before cardiac arrest team arrival during IHCA. Methods: We obtained data on IHCAs in 2016 and 2017 from the Danish nationwide registry on IHCA (DANARREST). Data included information on initial rhythm, type of defibrillator, time to first rhythm analysis, time to arrival of the cardiac arrest team, time to first defibrillation, and return of spontaneous circulation (ROSC). Results: Of 4,496 IHCAs, AEDs were used in 421 resuscitation attempts (9%). Time registrations were excluded for 6 non-shockable IHCAs due to errors in registration. Of the 421 IHCAs, 82% (n=347) were non-shockable and 16% (n=68) were shockable (data missing for 6 IHCAs). ROSC was achieved in 46% (n=158) of patients with non-shockable rhythms and 59% (n=40) of patients with shockable rhythms. For IHCAs with a shockable rhythm and usage of an AED, rhythm analysis was performed before arrival of the cardiac arrest team in 50% (n=34) of cases and defibrillation with an AED were performed in 46% (n=27) of the cases. Patients with shockable rhythms defibrillated before arrival of the cardiac team, more often achieved ROSC compared to patients defibrillated after cardiac arrest team arrival (p=0.0024). Data regarding time registration are shown in the table. Conclusion: AEDs are used in approximately 1 of 10 resuscitation attempts in Danish hospitals and contribute to defibrillation before arrival of the cardiac arrest team in 1 of 14 cardiac arrest patients.

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Out-of-hospital cardiac arrest

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0009 ◽

2021 ◽

pp. 76-87

Author(s):

Jerry P Nolan ◽

Christian Hassager

Keyword(s):

Cardiac Arrest ◽

Basic Life Support ◽

Life Support ◽

Spontaneous Circulation ◽

Neurological Injury ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Medical Emergencies ◽

Hospital Cardiac Arrest

Cardiac arrest is the most extreme of medical emergencies. If the victim is to have any chance of high-quality neurological recovery, cardiac arrest must be diagnosed quickly, followed by summoning for help as basic life support (chest compressions and ventilations) is started. In most cases, the initial rhythm will be shockable, but this will have often deteriorated to a non-shockable rhythm by the time a monitor and/or defibrillator is applied. While basic life support will sustain some oxygen delivery to the heart and brain and will help to slow the rate of deterioration in these vital organs, it is important to achieve restoration of a spontaneous circulation as soon as possible (by defibrillation if the rhythm is shockable). Once return of spontaneous circulation is achieved, the quality of post-cardiac arrest management will influence the patient's final neurological and cardiological outcome. These interventions aim to restore myocardial function and minimize neurological injury.

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

Circulation ◽

10.1161/circ.130.suppl_2.75 ◽

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

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Abstract 325: Characteristics and Outcomes of Hanging Induced Out-Of-Hospital Cardiac Arrest: Insights From the Paris Sudden Death Expertise Center Registry

Circulation ◽

10.1161/circ.140.suppl_2.325 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Arnaud Gille ◽

Richard Chocron ◽

Anna Ozguler ◽

Xavier JOUVEN ◽

Alain Cariou ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Spontaneous Circulation ◽

Low Flow ◽

Flow Duration ◽

Shockable Rhythm ◽

Younger Age ◽

Bystander Cardiopulmonary Resuscitation ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Introduction: Hanging-induced Out-of-Hospital cardiac arrest (OHCA) is poorly studied and a better understanding of these specific OHCA could be helpful to improve patients’ outcome. The main objective of our study was to describe characteristics and outcomes in patients who had OHCA from hanging injuries. Methods: From May 2011 to December 2017 we analyzed a prospectively collected Utstein database for all OHCA adults. All cases due to hanging were included. Utstein style variables were compared for 2 groups of patients: those with a Return of Spontaneous Circulation (ROSC) and those without (non-ROSC). Continuous data are described as means (extremes). Results: Among 25 055 OHCA, 500 patients were included. They were 49 (18-100) years old. Seventy-three (14.6%) hanging were witnessed and 58 (11.6%) benefited from a bystander cardiopulmonary resuscitation before Emergency Medical Service (EMS) arrival. No-flow duration was 29.1 (4-180) minutes. Advance life support was initiated by EMS in 299 (59.8%) cases. Low-flow duration was 23.8 (2-79) minutes. Nine patients (1.8%) had a shockable initial rhythm. We observed 83 (16.6%) ROSC. Four (0.8%) patients were discharged alive from hospital. They were all CPC 1. Table 1 compares characteristics with significant differences between ROSC and non-ROSC groups. Conclusion: As expected, younger age, short no-flow and low-flow durations and shockable rhythm on EMS arrival were significantly associated with ROSC. Overall prognosis is dramatically poor when OHCA is due to hanging (<1%), with a very low proportion of shockable rhythm, even if the rare survivors have an excellent CPC at discharge. Indeed, the best method to reduce the mortality rate of hanging is, with no contest, the prevention of suicidal act.

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In-hospital cardiac arrest resuscitation performed by the hospital emergency team: A 6-year retrospective register analysis at Danderyd University Hospital, Sweden

F1000Research ◽

10.12688/f1000research.15373.1 ◽

2018 ◽

Vol 7 ◽

pp. 1013 ◽

Cited By ~ 1

Author(s):

Hedwig Widestedt ◽

Jasna Giesecke ◽

Pernilla Karlsson ◽

Jan G. Jakobsson

Keyword(s):

Cardiac Arrest ◽

Sudden Cardiac Arrest ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

University Hospital ◽

Emergency Team ◽

Factors Associated ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Hospital Cardiac Arrest

Background: Cardiac arrest requires rapid and effective handling. Huge efforts have been implemented to improve resuscitation of sudden cardiac arrest patients. Guidelines around the various parts of effective management, the chain of survival, are available. The aim of the present retrospective study was to study sudden in-hospital cardiac arrest (IHCA) and the outcomes of emergence team resuscitation in a university hospital in Sweden. Methods: The Swedish Cardiopulmonary Resuscitation Registry was used to access all reported cases of IHCA at Danderyd Hospital from 2012 through 2017. Return of spontaneous circulation (ROSC), discharge alive, 30-day mortality and Cerebral Performance Scales score (CPC) were analysed. Results: 574 patients with cardiac arrests were included in the study: 307 patients (54%) had ROSC; 195 patients (34%) were alive to be discharged from hospital; and 191 patients (33%) were still alive at day-30 after cardiac arrest. Witnessed cardiac arrests, VT/VF as initial rhythm and experiencing cardiac arrest in high monitored wards were factors associated with success. However, 53% of patients’ alive at day-30 had a none-shockable rhythm, 16% showed initially a pulseless electrical activity and 37% asystole. CPC score was available for 188 out of the 195 patients that were alive to be discharged: 96.5% of patients where data was available had a favourable neurological outcome, a CPC-score of 1 or 2 at discharge, and only 6 of these patients had a CPC-score of 3 or higher (3%). Conclusions: One third of patients with sudden IHCA were discharged from hospital and alive at day-30, a clear majority without cognitive deficit related to the cardiac arrest. High monitored care, witnessed cardiac arrest and shockable rhythm were factors associated with high success; however, more than half of surviving patients had initially a none-shockable rhythm.

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Abstract 184: AED Application in Non-Shockable Out-of-Hospital Cardiac Arrest Does Not Reduce Survival

Circulation ◽

10.1161/circ.138.suppl_2.184 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Ross A Pollack ◽

Siobhan P Brown ◽

Thomas Rea ◽

Peter J Kudenchuk ◽

Myron L Weisfeldt

Keyword(s):

Cardiac Arrest ◽

Primary Outcome ◽

Patient Characteristics ◽

Neurological Status ◽

Relative Safety ◽

Initial Rhythm ◽

Bystander Cpr ◽

Rhythm Analysis ◽

In Transit ◽

Hospital Cardiac Arrest

Introduction: It is well established that AEDs improve outcome in shockable out-of-hospital cardiac arrest (OHCA). An increasing proportion (now the majority) of OHCAs present with non-shockable rhythms. Survival from non-shockable OHCA depends on high-quality CPR in transit to definitive care. Studies of AED use in non-shockable in-hospital arrest (as opposed to OHCA) have shown reduced survival with AED application possibly due to CPR interruptions to apply pads and perform rhythm analysis. We sought to determine whether AED application in non-shockable public, witnessed OHCA has a significant association with survival to discharge. Methods: This is a retrospective analysis of OHCA from 2010-2015 at 10 Resuscitation Outcomes Consortium centers. All adult, public, witnessed non-shockable OHCAs were included. Non-shockable arrest was defined as no shock delivered by the AED or by review of defibrillator tracings (10%). The initial rhythm on EMS arrival was used to confirm the rhythm. The primary outcome was survival to hospital discharge with favorable neurological status (modified rankin score <3). The OR was adjusted for the Utstein variables. Results: During the study period there were 1,597 non-shockable public, witnessed OHCA, 9.8% of which had an AED applied. The initial rhythm on EMS arrival was PEA or asystole in 86% of cases. Significantly more OHCA in the AED applied group had CPR performed. 6.5% of those without an AED applied survived with favorable neurologic status compared to 9% with an AED. After adjustment for the Utstein variables including bystander CPR, the aOR for survival with favorable neurologic outcome was 1.38 (95% CI:0.72-2.65). Conclusion: After adjusting for patient characteristics and bystander CPR, the application of an AED in non-shockable public witnessed OHCA had no significant association with survival or neurological outcome supporting the relative safety and potential benefit of AED application in non-shockable OHCA.

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Abstract P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year

Circulation ◽

10.1161/circ.118.suppl_18.s_1463 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jocelyn Berdowski ◽

Andra Schmohl ◽

Rudolph W Koster

Keyword(s):

Cardiac Arrest ◽

World Wide ◽

Prospective Observational Study ◽

Spontaneous Circulation ◽

Chest Compressions ◽

Return Of Spontaneous Circulation ◽

Resuscitation Guidelines ◽

Rhythm Analysis ◽

New Guidelines ◽

Hospital Cardiac Arrest

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines. Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005). Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1 ). Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.

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Pre-charging the defibrillator before rhythm analysis reduces hands-off time in patients with out-of-hospital cardiac arrest with shockable rhythm

Resuscitation ◽

10.1016/j.resuscitation.2021.09.037 ◽

2021 ◽

Author(s):

Bo Nees Iversen ◽

Carsten Meilandt ◽

Ulla Væggemose ◽

Christian Juhl Terkelsen ◽

Hans Kirkegaard ◽

...

Keyword(s):

Cardiac Arrest ◽

Shockable Rhythm ◽

Rhythm Analysis ◽

Hospital Cardiac Arrest ◽

Off Time

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Abstract 236: Regional Incidence and Outcome of Out-of-Hospital Cardiac Arrest Associated with Overdose

Circulation ◽

10.1161/circ.130.suppl_2.236 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

David D Salcido ◽

Allison C Koller ◽

Cesar D Torres ◽

Aaron M Orkin ◽

Rob H Schmicker ◽

...

Keyword(s):

Cardiac Arrest ◽

North America ◽

Prescription Drugs ◽

Regional Variation ◽

Spontaneous Circulation ◽

Research Network ◽

Shockable Rhythm ◽

Statistics Canada ◽

Population Counts ◽

Hospital Cardiac Arrest

Introduction: The frequency of lethal overdose due to prescription and non-prescription drugs is increasing in North America. The contribution of drug overdose (OD) to regional variation in the incidence and outcome out-of-hospital cardiac arrest (OHCA) is unclear. Objective: To estimate overall and regional variation in incidence and outcomes of emergency medical services (EMS)-treated OD-OHCA cases across North America. Methods: The Resuscitation Outcomes Consortium (ROC) is a clinical research network with 10 regional clinical centers in United States (US) and Canada that uses uniform methods for surveillance of all EMS-treated OHCA in participating regions. Cases of OHCA from 2006 to 2010 were reviewed for evidence of association with or without OD. Incidence of OD-OHCA was calculated as the number of OD-OHCA in a region per 100,000 cumulative person-years, using 2000 US Census and 2006 Statistics Canada population counts. Patient and EMS characteristics as well as outcome were described. Multiple logistic regression was used to describe the association between OD status on return of spontaneous circulation (ROSC) and survival to hospital discharge, while adjusting for case characteristics and consortium center. Results: Included were 56,272 cases of OHCA. Regional incidence of OD-OHCA varied between 0.5 and 2.7 per 100,000 person years (p<0.001), and proportion of OD-OHCA among all EMS-treated OHCA ranged from 0.9% to 3.8%. Table 1 shows outcomes and characteristics stratified by OD status; OD-OHCA were younger, less likely to be witnessed, and less likely to present with a shockable rhythm. Compared to non-OD, OD-OHCA was associated with ROSC (OR: 1.55; 95%CI: 1.35-1.78) and survival (OR: 2.14; 95%CI: 1.72-2.65). Conclusions: OD-OHCA are a small proportion of all OHCA, although incidence varied up to 5-fold across regions. OD-OHCA were more likely to survive than non-OD-OHCA.

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Abstract 219: Out-of-Hospital Cardiac Arrest in Vienna 2014

Circulation ◽

10.1161/circ.130.suppl_2.219 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Markus Keferböck ◽

Philip Datler ◽

Mario Krammel ◽

Elisabeth Lobmeyer ◽

Alexander Nürnberger ◽

...

Keyword(s):

Cardiac Arrest ◽

Outcome Measures ◽

Primary Outcome ◽

Sudden Cardiac Arrest ◽

Cerebral Performance Category ◽

Medical Personnel ◽

Shockable Rhythm ◽

Initial Rhythm ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Background: Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays. Method: Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated. Results: During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing. Conclusion: The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.

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Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest

Circulation ◽

10.1161/circ.130.suppl_2.44 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Lars W Andersen ◽

Katherine Berg ◽

Brian Z Saindon ◽

Joseph M Massaro ◽

Tia T Raymond ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Neurological Outcome ◽

Spontaneous Circulation ◽

National Registry ◽

Epinephrine Administration ◽

Negatively Associated ◽

Logistic Regression Models ◽

Shockable Rhythm ◽

Hospital Cardiac Arrest

Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age < 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97], per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.

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