Abstract 186: Sex Differences in Outcomes for Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Pavitra Kotini-Shah ◽  
Oksana Pugach ◽  
Ruizhe Chen ◽  
Marina Del Rios ◽  
Kimberly Vellano ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Sex Differences ◽  
Coronary Angiography ◽  
Neurological Outcome ◽  
The United States ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.

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

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

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

scholarly journals Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
SungJoon Park ◽  
Sung Woo Lee ◽  
Kap Su Han ◽  
Eui Jung Lee ◽  
Dong-Hyun Jang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Patient Characteristics ◽  
Related Factors ◽  
Neurological Outcomes ◽  
Upper Limit ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Off Time

Abstract Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration.

Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristian Kragholm ◽  
Monique Anderson ◽  
Carolina Malta Hansen ◽  
Phillip J. Schulte ◽  
Michael C. Kurz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Significant Survival ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

Abstract 475: Association Between Bystander Delay in Activating the Emergency Response System and Outcomes Following Out-Of-Hospital Cardiac Arrest: All-Japan National Utstein Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tomoyoshi Tamura ◽  
Tomohisa SEKI ◽  
Masaru Suzuki ◽  
Junichi Sasaki
Keyword(s):  
Cardiac Arrest ◽  
Emergency Response ◽  
Neurological Outcome ◽  
Epinephrine Administration ◽  
Emergency Response System ◽  
Response System ◽  
Chain Of Survival ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: An emphasis on the chain of survival has contributed to improved outcomes of out-of-hospital cardiac arrest (OHCA). Although immediate recognition of cardiac arrest (CA) and activation of the emergency response system are the first links in the chain of survival, their impact on outcomes is unclear. Hypothesis: Delayed time from collapse to activation of the emergency response system (bystander delay) is associated with an unfavorable neurological outcome after adult OHCA. Methods: Data from the prospective, nationwide, population-based All-Japan Utstein Registry of the Fire and Disaster Management Agency between January 1, 2012 and December 31, 2016 were analyzed. Of the 625,916 eligible cases, 164,256 adult, non-traumatic, witnessed OHCA including bystander delay times (age, 79 [IQR, 67-86] years; 60% male) were studied. The primary outcome measure was favorable neurological outcome 1 month after an OHCA, defined as a score of 1 or 2 on the Cerebral Performance Category Scale. Results: The median bystander delay time of 2.0 [1.0-4.0] min was shorter among patients who achieved a favorable outcome as compared to 3.0 [1.0-6.0] min (P < 0.001) for patients with an unfavorable outcome. In multivariable logistic regression analyses, bystander delay had an OR for favorable neurological outcome of 0.94 [95% CI, 0.93-0.97] after adjusting for age, sex, etiology of arrest, first documented rhythm, provision of bystander CPR, use of public access automated external defibrillator, epinephrine administration, time intervals of activation of the emergency response system and hospital arrival, and collapse to initiation of CPR, and regional location. Similarly, bystander delay was independently associated with reduced neurologically favorable survival among patients who received bystander CPR within one minute of collapse (adjusted OR, 0.97 [0.97-0.98]). Conclusions: Bystander delay was independently associated with decreased odds of neurologically favorable survival, even among patients for whom bystander CPR was immediately performed.

Abstract 340: Effect of the 2015 CPR Guidelines for Patients With Out-Of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm: Results From the All-Japan Utstein Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Eizo Tachibana ◽  
Naohiro Yonemoto ◽  
Yoshio Tahara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Population Based ◽  
Inclusion Criteria ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Favorable Neurological Outcome ◽  
Population Based Registry ◽  
Hospital Cardiac Arrest

Background: The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm, PEA and asystole, as an initial rhythm. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G), and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Results: The 109,175 patients who met the inclusion criteria comprised 18,764 who received CPR based on 2015G and 90,411 who received CPR based on 2010G. The figure showed favorable neurological outcomes at 30 days in the two groups. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in 2015G patients as compared to 2010G patients was 1.28 (95%CI 1.11-1.46, p<0.001). Conclusion: In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.

scholarly journals Survival and neurological recovery after out-of-hospital cardiac arrest

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Jarakovic ◽  
S Bjelica ◽  
M Kovacevic ◽  
M Petrovic ◽  
S Dimic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Study Group ◽  
St Segment Elevation ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health challenge and although rate of intrahospital survival increased over the last 40 years, it still remains poor (from 8,6% in 1976-1999 to 9,9% in 2000-2019). Different studies report that introduction of mild therapeutic hypothermia (TTM) improves survival and neurological outcome in comatose patients after OHCA.  Purpose The aim of this research was to evaluate influence of pre-hospital predictors related to cardiopulmonary resuscitation (CPR), neurological status and ECG changes at admission and early percutaneous coronary intervention (PCI) performed within 24h of admission on intrahospital survival and neurological outcome of OHCA patients. Methods The research was conducted as a retrospective cohort study of data taken from the hospital registry on OHCA from January 2007 until November 2019. The analyzed factors were: bystander CPR, duration of CPR until return of ROSC, initial rhythm, responsiveness upon admission defined as Glasgow Coma Score (GCS)&gt;8, presence of ST segment elevation (STEMI) on electrocardiography (ECG) and early PCI. The favorable neurological outcome was defined as a cerebral performance category scale (CPC)≤2. Results The research included 506 survivors of OHCA. Cardiac arrest was witnessed in 412 (81.4%), bystander CPR was performed in 197 (38.9%), CPR lasted ≤20min in 291 (57.5%), initial rhythm was shockable in 304 (60.1%) of patients. At admission 387 (76.5%) were comatose (GCS &lt; 8) and TTM was introduced in 177 (45.7%) of patients. ECG upon admission showed STEMI in 176 (34.8%) and early PCI was performed in 145 (28.6%) of patients. In-hospital mortality in our study group was 281 (55.5%) and 185 (36.6%) of patients had favorable neurological outcome. Multivariate regression analysis showed that initial shockable rhythm (OR 3.391 [2.310-4.977], p &lt; 0.0005), early PCI (OR 0.368 [0.226-0.599], p &lt; 0.0005), duration of CPR ≤20min (OR 4.249 [2.688-6.718], p &lt; 0.0005) and GCS &gt; 8 (OR 0.194 [0.110-0.343], p &lt; 0.0005) were independent predictors of in-hospital survival. Independent predictors of favorable neurological outcome were: initial shockable rhythm (OR 3.301 [2.002-5.441], p&lt; 0.0005), STEMI on ECG upon admission (OR 0.528 [0.326-0.853], p = 0.009), duration of CPR ≤20min (OR 5.144 [3.090-8.565], p&lt; 0.0005) and GCS &gt; 8 (OR 0.152 [0.088-0.260], p&lt; 0.0005). Introduction of TTM improved both intrahospital survival (54.1% vs. 24.4%; p &lt; 0.0005) and neurological outcome (33.5% vs. 11.6%; p &lt; 0.0005) in patients with initial shockable rhythm. Conclusion In our study group of OHCA patients of any origin, initial shockable rhythm, duration of CPR ≤20min and GCS &gt; 8 at admission influenced both intrahospital survival and favorable neurological outcome. Introduction of TTM significantly improved both survival and neurological outcome in comatose patients with initial shockable rhythm.

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

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

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

Abstract 2012: Relationship Between Adrenaline Concentration and Postresuscitation Syndrome in Patients with Return of Spontaneous Circulation (ROSC) After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kei Nishikawa ◽  
Ken Nagao ◽  
Kimio Kikushima ◽  
Kazuhiro Watanabe ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Epinephrine Administration ◽  
Cutoff Value ◽  
Neurological Outcomes ◽  
A Prospective Study ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background Although there is evidence that epinephrine hydrochloride favors initial ROSC, there is a paucity of evidence that it improves survival in humans. The value and safety of the Î 2 -adrenergic effects of epinephrine is controversial because they may lead to increase postresuscitation syndrome after ROSC. Few studies have investigated whether adrenaline concentration before epinephrine administration was related to incidence of postresuscitation syndrome. METHODS We did a prospective study of adult patients who achieved ROSC with standard cardiopulmonary resuscitation after out-of-hospital cardiac arrest. Blood samples to measure the adrenaline concentration were taken from a vein. The primary endpoint was neurological outcomes at hospital discharge. RESULTS Of the 274 adult patients with out-of-hospital cardiac arrest, 108(39%) achieved ROSC. The adrenaline levels ranged from 53 to 15,329pg/ml, with a median of 1,545pg/ml, and 25th and 75th percentile values of 707 and 4,486pg/ml, respectively. Of those, 71% (77/108) had an unfavorable neurological outcome and the adrenaline level was higher among such patients than among those with a favorable neurological outcome (a median, 2,016pg/ml vs. 938pg/ml, p=0.048). Moreover, the adrenaline level was higher among patients who died of postresuscitation syndrome within 24 hours of ROSC than among those with survival at 24 hours (a median, 3,290pg/ml vs. 1,343pg/ml, p=0.038). The adrenaline cutoff value of 944pg/ml for unfavorable neurological outcome had an accuracy of 70%. The adjusted odds ratio for the unfavorable neurological outcome after adrenaline cutoff value of 944pg/ml was 8.9 (95% CI, 2.2–35.9; p=0.002). On the other hand, the adrenaline level after epinephrine administration was 28 times as high as that before epinephrine administration (a median, 42,868pg/ml vs. 1,545pg/ml, p<0.0001). CONCLUSIONS In adult patients with ROSC after out-of-hospital cardiac arrest, adrenaline level before epinephrine administration was associated with incidence of postresuscitation syndrome, and the level was extremely increased after epinephrine administration. Epinephrine administration may lead to a severe toxic hyperadrenergic state in postresuscitation period.

Abstract 25: Early Coronary Angiography and Survival After Out-Of-Hospital Cardiac Arrest

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ankur Vyas ◽  
Paul Chan ◽  
Bryan McNally ◽  
Saket Girotra
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Propensity Score Analysis ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
C Statistic ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) are common rhythms seen in out-of-hospital cardiac arrest (OHCA). Although acute myocardial infarction is a frequent cause of VF and pulseless VT, it is unknown whether a strategy of early coronary angiography is associated with improved survival in patients with OHCA. Methods: Using data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 1810 adult patients who had an OHCA due to VF, pulseless VT, or an unknown but shockable rhythm and were successfully resuscitated and admitted to a hospital. Using a matched propensity score analysis, we examined the association between a strategy of early coronary angiography within the first day of cardiac arrest and survival to discharge. Results: Early coronary angiography was performed in 874 (48.3%) patients, of whom 523 (59.8%) received coronary stents. Compared to those without early angiography, patients undergoing early coronary angiography were younger (59.9 vs. 62.5 years); more likely to be men (77.9% vs. 64.5%), have a witnessed arrest (86.3% vs. 76.7%), have a diagnosis of ST-elevation myocardial infarction (STEMI) (68.5% vs. 20.3%); and less likely to have known cardiovascular disease (37.3% vs. 54.3%), diabetes (15.4% vs. 26.6%), and renal disease (3.7% vs. 8.3%) (P <0.01 for all comparisons). A total of 565 patients without early angiography were successfully matched to 565 patients with early coronary angiography (c-statistic of 0.77). A strategy of early coronary angiography was associated with higher rates of in-hospital survival (adjusted OR: 1.22, [1.02- 1.45], P=0.025). There were no differences in favorable neurological outcome between the two groups (adjusted OR: 1.10, [0.98-1.23], P=0.12). Conclusion: Among patients with an OHCA due to VF or pulseless VT who were successfully resuscitated and admitted to a hospital, a strategy of early coronary angiography was associated with better survival, which was not compromised by worse neurological outcomes. Given that many patients with an OHCA due to VF or pulseless VT do not currently undergo early coronary angiography, randomized trials are needed to confirm whether a strategy of early coronary angiography can improve outcomes in patients with OHCA.

Impact of Early Vasopressor Administration on Neurological Outcomes after Prolonged Out-of-Hospital Cardiac Arrest

2017 ◽  
Vol 32 (3) ◽  
pp. 297-304 ◽  
Author(s):  
Michael W. Hubble ◽  
Clark Tyson
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Medical Information ◽  
Cerebral Performance Category ◽  
Medical Information System ◽  
Publication Type ◽  
Neurological Outcomes ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

AbstractIntroductionVasopressors are associated with return of spontaneous circulation (ROSC), but no long-term benefit has been demonstrated in randomized trials. However, these trials did not control for the timing of vasopressor administration which may influence outcomes. Consequently, the objective of this study was to develop a model describing the likelihood of favorable neurological outcome (cerebral performance category [CPC] 1 or 2) as a function of the public safety answering point call receipt (PSAP)-to-pressor-interval (PPI) in prolonged out-of-hospital cardiac arrest.HypothesisThe likelihood of favorable neurological outcome declines with increasing PPI.MethodsThis investigation was a retrospective study of cardiac arrest using linked data from the Cardiac Arrest Registry to Enhance Survival (CARES) database (Centers for Disease Control and Prevention [Atlanta, Georgia USA]; American Heart Association [Dallas, Texas USA]; and Emory University Department of Emergency Medicine [Atlanta, Georgia USA]) and the North Carolina (USA) Prehospital Medical Information System. Adult patients suffering a bystander-witnessed, non-traumatic cardiac arrest between January 2012 and June 2014 were included. Logistic regression was used to calculate the adjusted odds ratio (OR) of neurological outcome as a function of PPI, while controlling for patient age, gender, and race; endotracheal intubation (ETI); shockable rhythm; layperson cardiopulmonary resuscitation (CPR); and field hypothermia.ResultsOf the 2,100 patients meeting inclusion criteria, 913 (43.5%) experienced ROSC, 618 (29.4%) survived to hospital admission, 187 (8.9%) survived to hospital discharge, and 155 (7.4%) were discharged with favorable neurological outcomes (CPC 1 or 2). Favorable neurological outcome was less likely with increasing PPI (OR=0.90; P<.01) and increasing age (OR=0.97; P<.01). Compared to patients with non-shockable rhythms, patients with shockable rhythms were more likely to have favorable neurological outcomes (OR=7.61; P<.01) as were patients receiving field hypothermia (OR=2.13; P<.01). Patient gender, non-Caucasian race, layperson CPR, and ETI were not independent predictors of favorable neurological outcome.ConclusionIn this evaluation, time to vasopressor administration was significantly associated with favorable neurological outcome. Among adult, witnessed, non-traumatic arrests, the odds of hospital discharge with CPC 1 or 2 declined by 10% for every one-minute delay between PSAP call-receipt and vasopressor administration. These retrospective observations support the notion of a time-dependent function of vasopressor effectiveness on favorable neurological outcome. Large, prospective studies are needed to verify this relationship.HubbleMW, TysonC. Impact of early vasopressor administration on neurological outcomes after prolonged out-of-hospital cardiac arrest. Prehosp Disaster Med. 2017; 32(3):297–304.

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