Abstract 313: Visualizing Out-Of-Hospital Cardiac Arrest in the Young: A Network Analysis of the Cardiac Arrest Registry for Enhanced Survival in Chicago

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Alyssa Vermeulen ◽  
Marina Del Rios ◽  
Teri L Campbell ◽  
Hai Nguyen ◽  
Hoang H Nguyen
Keyword(s):  
Cardiac Arrest ◽  
Network Analysis ◽  
Emergency Room ◽  
American Indians ◽  
Network Models ◽  
Spontaneous Circulation ◽  
Data Set ◽  
Qualitative And Quantitative ◽  
Complex Network Models ◽  
Hospital Cardiac Arrest

Introduction: The interactions of various variables on out-of-hospital cardiac arrest (OHCA) in the young (1-35 years old) outcomes are complex. Network models have emerged as a way to abstract complex systems and gain insights into relational patterns among observed variables. Hypothesis: Network analysis helps provide qualitative and quantitative insights into how various variables interact with each other and affect outcomes in OHCA in the young. Methods: A mixed graphical network analysis was performed using variables collected by CARES. The network allows the visualization and quantification of each unique interaction between two variables that cannot be explained away by other variables in the data set. The strength of the underlying interaction is proportional to the thickness of the connections (edges) between the variables (nodes). We used the mgm package in R. Results: Figure 1 shows the network of the OHCA in the young cases in Chicago from 2013 to 2017. There are apparent clusters. Sustained return of spontaneous circulation and hypothermia are strongly correlated with survival and neurological outcomes. This cluster is in turn connected to the rest of the network by survival to emergency room. The interaction between any two variables can also be quantified. For example, American Indians cases occur more often in disadvantaged locations when compared to Whites (OR 4.5). The network also predicts how much one node can be explained by adjacent nodes. Only 20% of survival to emergency room is explained by its adjacent nodes. The remaining 80% is attributed to variables not represented in this network. This suggests that interventions to improve this node is difficult unless further data is available. Conclusion: Network analysis provides both a qualitative and quantitative evaluation of the complex system governing OHCA in the young. The networks predictive capability could help in identifying the most effective interventions to improve outcomes.

Abstract 17847: Gasping is a Valid Predictor Of ROSC and Hospital Discharge for In-hospital Cardiac Arrest Occurring on the Ward

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Luca Marengo ◽  
Wolfgang Ummenhofer ◽  
Gerster Pascal ◽  
Falko Harm ◽  
Marc Lüthy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Survival Data ◽  
Neurological Outcome ◽  
Rapid Response Team ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Data Set ◽  
Hospital Cardiac Arrest

Introduction: Agonal respiration has been shown to be commonly associated with witnessed events, ventricular fibrillation, and increased survival during out-of-hospital cardiac arrest. There is little information on incidence of gasping for in-hospital cardiac arrest (IHCA). Our “Rapid Response Team” (RRT) missions were monitored between December 2010 and March 2015, and the prevalence of gasping and survival data for IHCA were investigated. Methods: A standardized extended in-hospital Utstein data set of all RRT-interventions occurring at the University Hospital Basel, Switzerland, from December 13, 2010 until March 31, 2015 was consecutively collected and recorded in Microsoft Excel (Microsoft Corp., USA). Data were analyzed using IBM SPSS Statistics 22.0 (IBM Corp., USA), and are presented as descriptive statistics. Results: The RRT was activated for 636 patients, with 459 having a life-threatening status (72%; 33 missing). 270 patients (59%) suffered IHCA. Ventricular fibrillation or pulseless ventricular tachycardia occurred in 42 patients (16% of CA) and were associated with improved return of spontaneous circulation (ROSC) (36 (97%) vs. 143 (67%; p<0.001)), hospital discharge (25 (68%) vs. 48 (23%; p<0.001)), and discharge with good neurological outcome (Cerebral Performance Categories of 1 or 2 (CPC) (21 (55%) vs. 41 (19%; p<0.001)). Gasping was seen in 128 patients (57% of CA; 46 missing) and was associated with an overall improved ROSC (99 (78%) vs. 55 (59%; p=0.003)). In CAs occurring on the ward (154, 57% of all CAs), gasping was associated with a higher proportion of shockable rhythms (11 (16%) vs. 2 (3%; p=0.019)), improved ROSC (62 (90%) vs. 34 (55%; p<0.001)), and hospital discharge (21 (32%) vs. 7 (11%; p=0.006)). Gasping was not associated with neurological outcome. Conclusions: Gasping was frequently observed accompanying IHCA. The faster in-hospital patient access is probably the reason for the higher prevalence compared to the prehospital setting. For CA on the ward without continuous monitoring, gasping correlates with increased shockable rhythms, ROSC, and hospital discharge.

scholarly journals Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

2019 ◽  
Vol 5 (2) ◽  
pp. 53
Author(s):  
Styliani Papadopoulou ◽  
Olympia Konstantakopoulou ◽  
Antonia Kalogianni ◽  
Martha Kelesi-Stavropoulou ◽  
Theodore Kapadohos
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Emergency Room ◽  
Survival Rates ◽  
Public Health Problem ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Discharged Patients ◽  
Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

scholarly journals P075: Impact of pit-crew CPR following out-of-hospital cardiac arrest in Saskatoon

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S103-S103
Author(s):  
S. Netherton ◽  
A. Leach ◽  
T. Hillier ◽  
R. Woods
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
The United States ◽  
Spontaneous Circulation ◽  
Full Data ◽  
Data Set ◽  
Automated External Defibrillators ◽  
Before And After ◽  
Collection Phase ◽  
Hospital Cardiac Arrest

Introduction: Between 1980 and 2008, survival rates following an out-of-hospital cardiac arrest (OHCA) have remained unchanged, averaging 7.6%. Despite the use of new and emerging technologies, new medications, and automated external defibrillators, survival remains low. Recently, a new focus in cardiopulmonary resuscitation (CPR) has shown dramatic improvements in survival post OHCA. This new model, called pit-crew CPR, focuses on minimizing interruptions in chest compressions and has each team member playing a specific role in the resuscitation, akin to the pit-crew of a car race. Certain districts in the United States and Canada have adopted the pit-crew, or a similar, high quality, maximum time-on-chest CPR model, with much success. We aim to determine whether the pit-crew model of CPR improves survival following OHCA in Saskatoon, SK. Methods: In Saskatoon, EMS and Fire crews respond to OHCAs and have been exclusively using the pit-crew model of CPR since Jan 1st, 2015. This study is a before and after retrospective chart analysis, comparing two groups - pre and post implementation of the pit-crew CPR model. The primary outcome is survival to hospital discharge post OHCA. Secondary outcomes include survival to admission and any return of spontaneous circulation (as per the Utstein definition). The inclusion criteria are patients >18 years old with a witnessed OHCA of presumed cardiac origin who receive CPR by EMS/Fire within the Saskatoon Ambulance service (MD Ambulance) catchment area. Patients were excluded if the OHCA was unwitnessed, or if there was a presumed non-cardiac cause for the arrest, e.g. trauma. Results: In the pre-pit-crew model cohort, between Jan 1st, 2011 and Sept 31st, 2014, 455 OHCAs were analyzed. In this cohort 10.5% survived to discharge, 31.9% survived to admission and ROSC was achieved in 39% of cases. The percentage of patients with initial rhythms of VF/VT, asystole or PEA were 28.5% (26%), 41.5% (1%) and 23.6% (10%) respectively, with survival to discharge shown in parentheses. The post-pit-crew cohort is still in the data collection phase. Conclusion: Our pre-pit crew cohort data has been collected and analyzed. With ongoing data acquisition for the post-pit crew cohort, we hope to have the full data set complete by the end of 2018. It will be at that time when we are able to determine whether the pit-crew model of CPR improves survival to discharge following OHCA in Saskatoon.

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.

scholarly journals Thromboelastometric analysis of the risk factors for return of spontaneous circulation in adult patients with out-of-hospital cardiac arrest

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0175257 ◽  
Author(s):  
Hiroyuki Koami ◽  
Yuichiro Sakamoto ◽  
Ryota Sakurai ◽  
Miho Ohta ◽  
Hisashi Imahase ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Return Of Spontaneous Circulation ◽  
Hospital Cardiac Arrest

Abstract 13721: The Monitoring of rSO2 Value During CPR is Useful for High-Quality CPR

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yoshihito Ogawa ◽  
Tadahiko Shiozaki ◽  
Tomoya Hirose ◽  
Mitsuo Ohnishi ◽  
Goro Tajima ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Clinical Utility ◽  
Spontaneous Circulation ◽  
Regional Cerebral Oxygen Saturation ◽  
High Quality ◽  
Specificity And Sensitivity ◽  
Single Center Study ◽  
Manual Chest Compression ◽  
Hospital Cardiac Arrest

[Background] Recently, the patients with out-of-hospital cardiac arrest are increasing. It is very important to do chest compression continuously for the return of spontaneous circulation (ROSC). But we can not but stop chest compression during checking pulse every few minutes. We reported that Regional cerebral Oxygen Saturation (rSO2) value was not elevated by manual chest compression and mechanical chest compression increased a little rSO2 value on CPR without ROSC and rSO2 value became a good parameter of ROSC in single center study. [Purpose] The purpose of this study is to evaluate clinical utility of rSO2 value during CPR in multicenter study. [Method] Retrospectively, we considered the rSO2 value of the out-of -hospital cardiac arrest patients from December 2012 to December 2014 in multicenter. During CPR, rSO2 were recorded continuously from the forehead of the patients by TOS-OR (Japan). CPR for patients with OHCA was performed according to the JRC-guidelines 2010. [Result] 252 patients with OHCA were included in this study. The rSO2 value on arrival, during CPR and ROSC were 44.4±8.9%, 45.4±9.7%, 58.6±9.2%. In ROSC, with rSO2 cutoff value of 52.7%, the specificity and sensitivity were 80% and 79%, respectively. The negative predict value was 99.2%, respectively. It means little possible to ROSC, if the rSO2 value is less than 52.7%. So, it may be possible to reduce the frequency of checking pulse during CPR. [Conclusion] The monitoring of rSO2 value could reduce the frequency of checking pulse during CPR and do chest compression continuously.

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