Abstract 24: Association Between Serum Lactate During Cardiopulmonary Resuscitation and Survival in Adult Out-Of-Hospital Cardiac Arrest: A Multicenter Cohort Study (The Critical Study in Osaka, Japan)

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Norihiro Nishioka ◽  
Daisuke Kobayashi ◽  
Junichi Izawa ◽  
Takeyuki Kiguchi ◽  
Tetsuhisa Kitamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Lactate Level ◽  
Serum Lactate ◽  
Critical Study ◽  
Serum Lactate Level ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Lactate Levels ◽  
Hospital Cardiac Arrest

Background: Serum lactate reflects hypoxic insult in many conditions, but its role as prognostic markers after cardiac arrest is still controversial. This study aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: This study analyzed the data of the Osaka Comprehensive Registry of Intensive Care for OHCA Survival, a prospective multicenter observational study of 14 participating institutions in Osaka Prefecture, Japan. We enrolled consecutive patients aged ≥18 years who were transported to the hospital with ongoing CPR from 2013 to 2016. Based on the serum lactate levels, OHCA patients were divided into 4 quartiles: Q1 (lactate ≤10.6 mEq/L), Q2 (10.6< lactate ≤14.1 mEq/L), Q3 (14.1< lactate ≤18.0 mEq/L) and Q4 (lactate >18.0 mEq/L). The relationships between serum lactate level before return of spontaneous circulation (ROSC) and 1-month survival were assessed. Results: A total of 3,674 OHCA patients were included in the analysis. Overall 1-month survival was 2.3% (88/3,674). The Q1 group had the highest 1-month survival (4.6% [42/921]), followed by Q2 (2.7% [25/920]), Q3 (1.1% [11/966]) and Q4 (0.6% [5/867]), respectively (p for trend < 0.001). In the multivariable logistic regression analysis, the proportion of 1-month survival in the Q4 group was significantly lower, compared with that in the Q1 group (adjusted odds ratio 0.23; 95% confidence interval 0.09 to 0.60). The adjusted proportion of 1-month survival decreased in a stepwise manner across increasing quartiles (p for trend <0.001). In a subgroup analysis by initial rhythm, there was a significant interaction (p=0.003) between the rhythms: 1-month survival of OHCA patients presented with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but in patients with a shockable rhythm the similar trend was not observed (p for trend = 0.574). Conclusions: The high serum lactate level before ROSC significantly associated with the worse 1-month survival after OHCA. Serum lactate may be one of the effective prognostic indications for OHCA during CPR, especially with non-shockable initial rhythm.

scholarly journals Association Between Serum Lactate Level During Cardiopulmonary Resuscitation and Survival in Adult Out-of-Hospital Cardiac Arrest: A Multicenter Cohort Study (The Critical Study in Osaka, Japan)

2020 ◽  
Author(s):  
Norihiro Nishioka ◽  
Daisuke Kobayashi ◽  
Junichi Izawa ◽  
Taro Irisawa ◽  
Tomoki Yamada ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Lactate Level ◽  
Serum Lactate ◽  
Critical Study ◽  
Multivariable Logistic Regression Analysis ◽  
Serum Lactate Level ◽  
Shockable Rhythm ◽  
Lactate Levels ◽  
Hospital Cardiac Arrest

Abstract Background: Serum lactate reflects hypoxic insult in many conditions, but its role as prognostic markers after cardiac arrest is still controversial. This study aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA).Methods:We analyzed the data of the Osaka Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study, a prospective multicenter observational study of 14 participating institutions in Osaka Prefecture, Japan that enrolled consecutive OHCA patients. We included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR from 2013 to 2017. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (lactate ≤ 10.6 mEq/L), Q2 (10.6 < lactate ≤ 14.1 mEq/L), Q3 (14.1 < lactate ≤ 18.0 mEq/L), and Q4 (lactate > 18.0 mEq/L). The primary outcome of this study was 1-month survival. Results:A total of 11,960 patients were registered and 4,978 of them were eligible for our analyses. The Q1 group had the highest 1-month survival (4.3% [53/1,245]), followed by Q2 (2.5% [31/1,245]), Q3 (1.1% [14/1,328]), and Q4 (0.5% [6/1,160]) groups. In the multivariable logistic regression analysis, the proportion of 1-month survival in the Q4 group was significantly lower than that in the Q1 group (adjusted odds ratio 0.21; 95% confidence interval 0.086 to 0.50). One-month survival decreased in a stepwise manner as the quartiles increased (p for trend <0.001). In subgroup analysis, there was a significant interaction between initial rhythm and survival (p for interaction <0.001); 1-month survival of patients with a non-shockable rhythm decreased when the lactate levels increased (p for trend <0.001), but not in patients with a shockable rhythm (p for trend =0.76).CONCLUSION:High serum lactate level during CPR was associated with poor 1-month survival in OHCA patients. Serum lactate may be one of the effective prognostic indications for OHCA during CPR, especially in patients with non-shockable rhythm.

scholarly journals Association between serum lactate level during cardiopulmonary resuscitation and survival in adult out-of-hospital cardiac arrest: a multicenter cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Norihiro Nishioka ◽  
◽  
Daisuke Kobayashi ◽  
Junichi Izawa ◽  
Taro Irisawa ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Lactate Level ◽  
Serum Lactate ◽  
Multivariable Logistic Regression Analysis ◽  
Serum Lactate Level ◽  
Multicenter Cohort Study ◽  
Shockable Rhythm ◽  
Lactate Levels ◽  
Hospital Cardiac Arrest

AbstractWe aimed to investigate the association between serum lactate levels during cardiopulmonary resuscitation (CPR) and survival in patients with out-of-hospital cardiac arrest (OHCA). From the database of a multicenter registry on OHCA patients, we included adult nontraumatic OHCA patients transported to the hospital with ongoing CPR. Based on the serum lactate levels during CPR, the patients were divided into four quartiles: Q1 (≤ 10.6 mEq/L), Q2 (10.6–14.1 mEq/L), Q3 (14.1–18.0 mEq/L), and Q4 (> 18.0 mEq/L). The primary outcome was 1-month survival. Among 5226 eligible patients, the Q1 group had the highest 1-month survival (5.6% [74/1311]), followed by Q2 (3.6% [47/1316]), Q3 (1.7% [22/1292]), and Q4 (1.0% [13/1307]) groups. In the multivariable logistic regression analysis, the adjusted odds ratio of Q4 compared with Q1 for 1-month survival was 0.24 (95% CI 0.13–0.46). 1-month survival decreased in a stepwise manner as the quartiles increased (p for trend < 0.001). In subgroup analysis, there was an interaction between initial rhythm and survival (p for interaction < 0.001); 1-month survival of patients with a non-shockable rhythm decreased when the lactate levels increased (p for trend < 0.001), but not in patients with a shockable rhythm (p for trend = 0.72). In conclusion, high serum lactate level during CPR was associated with poor 1-month survival in OHCA patients, especially in patients with non-shockable rhythm.

scholarly journals Monitoring of serum lactate level during cardiopulmonary resuscitation in adult in-hospital cardiac arrest

Critical Care ◽  
2015 ◽  
Vol 19 (1) ◽  
Author(s):  
Chih-Hung Wang ◽  
Chien-Hua Huang ◽  
Wei-Tien Chang ◽  
Min-Shan Tsai ◽  
Ping-Hsun Yu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Lactate Level ◽  
Serum Lactate ◽  
Serum Lactate Level ◽  
Hospital Cardiac Arrest

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

Circulation ◽  
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.

Abstract 208: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome in Patients With Refractory Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Takashi Unoki ◽  
Daisuke Takagi ◽  
Yudai Tamura ◽  
Hiroto Suzuyama ◽  
Eiji Taguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Intervention Period ◽  
Post Intervention ◽  
Shockable Rhythm ◽  
Time Period ◽  
Simulation Based ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Prolonged conventional cardiopulmonary resuscitation (C-CPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with cardiac arrest unresponsive to C-CPR. However, the indication and optimal duration to switch from C-CPR to E-CPR are not well established. In addition, the opportunities to develop teamwork skills and expertise to mitigate risks are few. We thus developed the implementation protocol for the E-CPR simulation program, and investigated whether the faster deployment of extracorporeal membrane oxygenation (ECMO) improves the neurological outcome in patients with refractory OHCA. Methods: A total of 42 consecutive patients (age 58±16 years, male ratio 90%, and initial shockable rhythm 64%) received E-CPR (3% of OHCA) during the study period. Among them, 32 (76%) were deployed ECMO during the pre-intervention time period (Pre: from January 2012 to September 2017), whereas 10 (24%) were deployed during the post-intervention time period (Post: October 2017 to May 2019). We compared the door to E-CPR time, collapse to E-CPR time, 30-day mortality, and favorable neurological outcome (Cerebral Performance Categories 1, 2) between the two periods. Results: There was no significant difference in age, the rates of male sex and shockable rhythm, and the time form collapse to emergency room admission between the two periods. The door to E-CPR time and the collapse to E-CPR time were significantly shorter in the post-intervention period compared to the pre-intervention period (Pre: 39 min [IQR; 30-50] vs. Post: 29 min [IQR; 22-31]; P=0.007, Pre: 76 min [IQR; 58-87] vs. Post: 59 min [IQR; 44-68]; P=0.02, respectively). The 30-day mortality was similar between the two periods (Pre: 88% vs. Post: 80%; P=0.6). In contrast, the rate of favorable neurological outcome at the time of discharge was significantly higher in post-intervention period (Pre: 0% vs. Post: 20%; P=0.01) compared to the pre-intervention period. Conclusion: A comprehensive simulation-based training for E-CPR seems to improve the neurological outcome in patients with refractory OHCA patients.

scholarly journals Implementation of a National 5‐Year Plan for Prehospital Emergency Care in Singapore and Impact on Out‐of‐Hospital Cardiac Arrest Outcomes From 2011 to 2016

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Andrew Fu Wah Ho ◽  
Nurun Nisa Amatullah De Souza ◽  
Audrey L. Blewer ◽  
Win Wah ◽  
Nur Shahidah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Care ◽  
Survival Rates ◽  
Prehospital Emergency Care ◽  
Shockable Rhythm ◽  
Automated External Defibrillation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Prehospital Emergency ◽  
Hospital Cardiac Arrest

Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% ( P =0.006). Overall survival rates improved from 3.6% to 6.5% ( P <0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.

P492Estimation of no-flow duration and survival in patients with an initial shockable rhythm after out-of-hospital cardiac arrest

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
F Okada ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Flow Duration ◽  
Shockable Rhythm ◽  
Number Of Patients ◽  
Initial Rhythm ◽  
The Relationship ◽  
Neurologically Intact ◽  
Utstein Style ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Japan Society for the Promotion of Science (KAKENHI Grant No. 18K09999) Background In patients with unwitnessed out-of-hospital cardiac arrest (OHCA), the actual no-flow duration (the time with no organ perfusion) is unclear. However, when these patients have a shockable rhythm as an initial recorded rhythm, the no-flow duration may be relatively short as compared with other initial rhythms, and some patients can obtain a good functional outcome after OHCA. Purpose The purpose of the present study was to estimate the no-flow duration and to determine the relationship between no-flow duration and neurologically intact survival in patients with an initial shockable rhythm after OHCA. Methods We reviewed 82,464 patients with OHCA (aged ≥18 years, non-traumatic, witnessed, and without any bystander interventions) who were included in the All-Japan Utstein-style registry from 2013 to 2017. The study end point was 1-month neurologically intact survival (Cerebral Performance Category scale 1 or 2). No-flow duration was defined as the time from emergency call to emergency medical services (EMS) arrival at the patient site. Results The rate of 1-month neurologically intact survival in the patients with an initial shockable rhythm (n = 10,384, 12.6% of overall patients) was 16.5% (1718/10,384). No-flow duration was significantly and inversely associated with 1-month neurologically intact survival (adjusted odds ratios for 1-minute increments: 0.85, 95% confidence interval: 0.84–0.86). The proportion of patients with a shockable rhythm to the overall patients (y, %) had a high correlational relationship with no-flow duration (x, min), depicted by y = 21.0 - 0.95 × x, R² = 0.935. In this analytical model, the number of patients with shockable rhythm reached null at 22 minutes of no-flow duration. The no-flow durations, beyond which the chance for initial shockable rhythm diminished to &lt;10%, &lt;5%, and &lt;1%, were 12, 13, and 17 minutes, respectively. The rate of neurologically intact survival in the patients with shockable rhythm (y, %) and no-flow duration (x, min) were also found to have a strong correlation, depicted by y = 0.16 × x² - 5.12 × x + 45.0, R² = 0.907. The no-flow durations, beyond which the chance for 1-month neurologically intact survival diminished to &lt;10%, &lt;5%, and &lt;1%, were 10, 11, and 15 minutes, respectively. Conclusions In OHCA patients without any bystander interventions before EMS personnel arrival, when a shockable rhythm is recorded by EMS personnel as an initial rhythm, the no-flow duration after cardiac arrest is highly likely to be &lt;17 minutes regardless of the layperson witness status. The limitation of no-flow duration to obtain a 1-month neurologically intact survival after OHCA may be 15 minutes when the patients have an initial shockable rhythm.

scholarly journals Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: nationwide cohort study

BMJ ◽  
2019 ◽  
pp. l430 ◽  
Author(s):  
Junichi Izawa ◽  
Sho Komukai ◽  
Koichiro Gibo ◽  
Masashi Okubo ◽  
Kosuke Kiyohara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Time Dependent ◽  
Adjusted Risk ◽  
Shockable Rhythm ◽  
Adjusted Risk Ratio ◽  
Advanced Airway ◽  
Sequential Matching ◽  
Hospital Cardiac Arrest

Abstract Objective To determine survival associated with advanced airway management (AAM) compared with no AAM for adults with out-of-hospital cardiac arrest. Design Cohort study between January 2014 and December 2016. Setting Nationwide, population based registry in Japan (All-Japan Utstein Registry). Participants Consecutive adult patients with out-of-hospital cardiac arrest, separated into two sub-cohorts by their first documented electrocardiographic rhythm: shockable (ventricular fibrillation or pulseless ventricular tachycardia) and non-shockable (pulseless electrical activity or asystole). Patients who received AAM during cardiopulmonary resuscitation were sequentially matched with patients at risk of AAM within the same minute on the basis of time dependent propensity scores. Main outcome measures Survival at one month or at hospital discharge within one month. Results Of the 310 620 patients eligible, 8459 (41.2%) of 20 516 in the shockable cohort and 121 890 (42.0%) of 290 104 in the non-shockable cohort received AAM during cardiopulmonary resuscitation. After time dependent propensity score sequential matching, 16 114 patients in the shockable cohort and 236 042 in the non-shockable cohort were matched at the same minute. In the shockable cohort, survival did not differ between patients with AAM and those with no AAM: 1546/8057 (19.2%) versus 1500/8057 (18.6%) (adjusted risk ratio 1.00, 95% confidence interval 0.93 to 1.07). In the non-shockable cohort, patients with AAM had better survival than those with no AAM: 2696/118 021 (2.3%) versus 2127/118 021 (1.8%) (adjusted risk ratio 1.27, 1.20 to 1.35). Conclusions In the time dependent propensity score sequential matching for out-of-hospital cardiac arrest in adults, AAM was not associated with survival among patients with shockable rhythm, whereas AAM was associated with better survival among patients with non-shockable rhythm.

scholarly journals Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study

2019 ◽  
Vol 41 (21) ◽  
pp. 1961-1971 ◽  
Author(s):  
Wulfran Bougouin ◽  
Florence Dumas ◽  
Lionel Lamhaut ◽  
Eloi Marijon ◽  
Pierre Carli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Conditional Logistic Regression ◽  
Time Duration ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Factors Associated ◽  
Hospital Survival ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest ◽  
Extracorporeal Cpr

Abstract Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002). Conclusions In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

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