Abstract 367: Ventricular Assist Device Association in Improving Outcomes in Patients Resuscitated From Out of Hospital Cardiac Arrest

Introduction: There has been continued debate and limited research on the efficacy of ventricular assist devices such as intra-aortic balloon pumps and Impella devices on improving survival outcomes in post cardiac arrest patients. Objective: The primary objective of this study is to assess whether the use of ventricular assist devices is associated with improved survival outcome in patients resuscitated from out-of-hospital cardiac arrest in Michigan. Methods: We matched cardiac arrest cases from 2014-2017 in the Michigan CARES Registry (CARES) and the Michigan Inpatient Database (MIDB) using probabilistic linkage. Ventricular assist devices (VAD) are defined as either Intra-aortic balloon pump (IABP) or Impella device identified using ICD-9 or 10 procedure codes. Multilevel, multivariable regression analyses were employed to evaluate the impact of device use on survival to hospital discharge, adjusting for variables normally predictive of cardiac arrest survival (age, location, witnessed, shockable rhythm). Results: A total of 3,790 CARES cases were matched with the MIDB of which 183 (4.8%) received IABP, 50 (1.3%) received impella devices, and 1,131 (29.8%) survived to hospital discharge. VAD use was associated with improved survival to discharge (OR=2.07, 95% CI 1.55, 2.77). IABP were used more frequently and associated with an improved outcome (OR=2.16, 95%CI 1.59, 2.93) compared to the Impella device (OR=1.72, 95% CI 0.96, 3.06). In a multivariable model, however, VAD use was no longer associated with an improved outcome (aOR =0.95, 95% CI 0.69, 1.31). In the subset of patients with a diagnosis of cardiogenic shock (n=725) we identified an improved survival to discharge with VAD use (OR= 1.84 95% CI 1.24, 2.73). IABP use was more frequent and associated with an improved outcome (OR=1.98, 95% CI 1.32, 2.98). After adjusting for patient characteristics, VAD use increased the odds of an improved outcome by 14% but was not statistically significant (aOR = 1.14, 95% CI 0.74, 1.77 ). Conclusion: Although limited by a low frequency of use, VAD or IABP alone was associated with improved outcome for post arrest care. However, in a multivariable analysis, VAD use was not associated with an independent improvement in post arrest survival.

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The impact of ventricular fibrillation amplitude on successful cardioversion, resuscitation duration, and survival after out-of-hospital cardiac arrest

Critical Care and Resuscitation ◽

10.51893/2021.2.oa7 ◽

2021 ◽

Vol 23 (2) ◽

pp. 202-210

Author(s):

Ziad Nehme ◽

◽

Steffi Burns ◽

Jocasta Ball ◽

Stephen Bernard ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Hospital Discharge ◽

Medical Service ◽

Multivariable Analysis ◽

Shock Amplitude ◽

International Data ◽

Low Amplitude ◽

The Impact ◽

Hospital Cardiac Arrest

OBJECTIVE: We sought to examine the incidence of low amplitude ventricular fibrillation and its impact on successful cardioversion, duration of resuscitation, and survival to hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). DESIGN: Retrospective analysis from a statewide registry. SETTING: Victoria, Australia. PARTICIPANTS: Consecutive initial ventricular fibrillation arrests with an emergency medical service (EMS)-attempted resuscitation between 1 February 2019 and 30 January 2020. MAIN OUTCOME MEASURES: Survival to hospital discharge, successful cardioversion, and duration of resuscitation. RESULTS: Of the 471 initial ventricular fibrillation arrests, 429 (91.1%) had sufficient electrocardiogram data for review. The median initial and final ventricular fibrillation amplitude did not differ (0.3 mV; interquartile range [IQR], 0.2–0.5 mV). The final pre-shock amplitude was ≤ 0.1 mV (very fine) and ≤ 0.2 mV (fine) in 22.8% and 37.5% of cases respectively. In a multivariable analysis, only the time between emergency call and first defibrillation was associated with a low initial ventricular fibrillation amplitude ≤ 0.2 mV (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02–1.13; P = 0.004). After adjustment for arrest factors, every 0.1 mV increase in final amplitude was independently associated with survival to hospital discharge (aOR, 1.26; 95% CI, 1.14–1.39; P < 0.001) and initial cardioversion success (aOR, 1.19; 95% CI, 1.07–1.32; P = 0.001). The duration of resuscitation also increased by 1.7 minutes (95% CI, 1.03–2.36; P < 0.001) for every 0.1 mV increase in final amplitude. CONCLUSION: More than one-third of initial ventricular fibrillation OHCA cases were low in amplitude. Comparative international data are needed to better understand how low amplitude ventricular fibrillation rhythms confound the measurement of OHCA interventions and international benchmarks for survival outcomes.

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Abstract 332: Long-term Post-discharge Survival and Healthcare Utilization Following Out-of-hospital Cardiac Arrest: Insights From a Novel Province-wide Linkage

Circulation ◽

10.1161/circ.142.suppl_4.332 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Christopher B Fordyce ◽

Brian E Grunau ◽

Meijiao Guan ◽

May K Lee ◽

Nathaniel M Hawkins ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Composite Endpoint ◽

Post Discharge ◽

Hospital Factors ◽

The Impact ◽

Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with poor short-term outcomes. However, the impact of pre- and in-hospital factors on long-term outcomes is ill-defined, mainly related to challenges combining disparate data sources. Methods: We linked adult non-traumatic EMS-treated OHCAs from the British Columbia Cardiac Arrest Registry (Jan 2009 - Dec 2016) to provincial datasets describing co-morbidities, medications, procedures, mortality, and hospital admission and discharge. Among hospital-discharge survivors, we examined the 3-year composite endpoint of mortality ± all-cause readmission using the Kaplan-Meier (KM) method and multivariable Cox model for predictors. Results: Of 10,876 successfully linked OHCAs, 1325 survived to hospital discharge: mean age 62.8 years, 77.9% male, 72.6% shockable rhythms, 60.1% non-public locations, 69.1% bystander CPR, and 30.3% STEMI. During admission, 78.6% required mechanical ventilation, 69.1% received coronary angiography (37.5% PCI, 10.3% CABG), and 24.8% received an ICD. At 3 years post-discharge, the estimated KM event rates were 15.9% (95% CI 13.9%, 19.3%) for mortality and 68.2% (95% CI 65.3%, 71.0%) for mortality and readmission, which differed by age, initial rhythm, and arrest location ( Figure ). Following multivariable analysis, patients with a history of HF [HR 1.62 (95% CI 1.34 - 1.96)], age >75 [1.62 (1.35, 1.96)], anticoagulation use [2.55 (1.36, 4.79)], non-shockable rhythm [1.29 (1.07, 1.55)] and non-public arrest location [1.21(1.04, 1.40)] were more likely to experience the composite endpoint; those receiving coronary angiography were less likely [0.79 (0.64, 0.98)]. Conclusions: The long-term death or readmission risk persists even among OHCA hospital-discharge survivors, and is associated with both pre- and in-hospital factors. An enriched, linked dataset detailing the entire OHCA “journey” may be a promising tool to identify care and treatment gaps.

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156 Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.6 ◽

2020 ◽

Vol 37 (12) ◽

pp. 825.1-825

Author(s):

Ed Barnard ◽

Daniel Sandbach ◽

Tracy Nicholls ◽

Alastair Wilson ◽

Ari Ercole

Keyword(s):

Overall Survival ◽

Cardiac Arrest ◽

Hospital Admission ◽

Hospital Discharge ◽

Multivariable Analysis ◽

Discharge Data ◽

Successful Resuscitation ◽

Bystander Cpr ◽

Number Percentage ◽

Hospital Cardiac Arrest

Aims/Objectives/BackgroundOut-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. Aim: to compare differential determinants of survival to hospital admission and survival to hospital discharge for traumatic (TCA) and non-traumatic cardiac arrest (NCTA).Methods/DesignAn analysis of 9109 OHCA in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for NTCA and TCA. Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. Data reported as number (percentage), number (percentage (95% CI)) and median (IQR) as appropriate. Continuous data have been analysed with a Mann-Whitney U test, and categorical data have been analysed with a χ2 test. Analyses were performed using the R statistical programming language.Results/ConclusionsThe incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95%CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95%CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander-CPR was dependent on geographical socioeconomic status.NTCA and TCA are clinically distinct entities with different predictors for outcome and should be reported separately. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas.

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Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽

10.1161/circ.132.suppl_3.18656 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Ian R Drennan ◽

Steve Lin ◽

Kevin E Thorpe ◽

Jason E Buick ◽

Sheldon Cheskes ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Spontaneous Circulation ◽

Targeted Temperature Management ◽

Neurologic Outcome ◽

Temperature Management ◽

Neurologic Injury ◽

Good Neurologic Outcome ◽

The Impact ◽

Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

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Myocardial recovery: a focus on the impact of left ventricular assist devices

Expert Review of Cardiovascular Therapy ◽

10.1586/14779072.2014.909729 ◽

2014 ◽

Vol 12 (5) ◽

pp. 589-600 ◽

Cited By ~ 4

Author(s):

M Scott Halbreiner ◽

Vincent Cruz ◽

Randall Starling ◽

Edward Soltesz ◽

Nicholas Smedira ◽

...

Keyword(s):

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Myocardial Recovery ◽

Ventricular Assist ◽

Assist Devices ◽

Left Ventricular Assist ◽

The Impact

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Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices

Journal of Clinical Medicine ◽

10.3390/jcm10163623 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3623

Author(s):

Stéphane Manzo-Silberman ◽

Christoph Nix ◽

Andreas Goetzenich ◽

Pierre Demondion ◽

Chantal Kang ◽

...

Keyword(s):

Cardiac Arrest ◽

Myocardial Dysfunction ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Ejection ◽

Ventricular Assist ◽

Ventricular Ejection Fraction ◽

Assist Devices ◽

Significant Difference ◽

Left Ventricular Assist

Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated.

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LO08: Effect of an intact “chain of survival” sequence on survival to discharge from out-of-hospital cardiac arrest

CJEM ◽

10.1017/cem.2017.70 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S30

Author(s):

D.L. Andrusiek ◽

R.B. Abu-Laban ◽

J.M. Tallon ◽

S. Sheps ◽

K. Joseph

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Endotracheal Intubation ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Research Network ◽

Independent Effect ◽

Chain Of Survival ◽

The Impact ◽

Hospital Cardiac Arrest

Introduction: The “chain of survival” is a 5-link theoretical construct that has been central to cardiac arrest resuscitation for over 40 years. Although the role of each link has been extensively studied, little is known about the impact of performing the chain of survival in sequence. The purpose of this study was to estimate the proportion of out-of-hospital cardiac arrest (OHCA) responses by Emergency Medical Services (EMS) that had an intact chain of survival sequence response, and the effect of this on survival to hospital discharge. Methods: We conducted a prospective cohort study of adult (>age 20 years) OHCA patients using data collected between 2005-2007 by the Resuscitation Outcomes Consortium (ROC). ROC is a research network involving 10 research sites and 264 EMS agencies across North America. Using routinely collected data, we coded cases as receiving an intact or non-intact chain of survival sequence based on EMS cardio pulmonary resuscitation (CPR), rhythm analysis or defibrillation, epinephrine administration or endotracheal intubation, and transport to a hospital with an electrophysiology lab or percutaneous coronary intervention capability, contingent on the patient’s condition when EMS arrived. Multiple variable logistic regression was performed, adjusting for known (Utstein) survival predictors, to estimate the independent effect of intact chain of survival sequence on survival to hospital discharge. REB approval was obtained. Results: We enrolled12,821 OHCA cases, of which, 29.4% (n=3,773) had an intact chain of survival and 7.6% (n=972) survived to hospital discharge. Cases with an intact chain of survival were younger, and more likely to arrest in public, receive bystander CPR, occur in the USA and specific ROC sites, and had faster EMS response times. The adjusted odds ratio of survival to hospital discharge with an intact chain of survival sequence was 2.4 (95% CI: 2.1-2.8). A sensitivity analysis of 4,056 cases with known timing of endotracheal intubation found a similar adjusted odds ratio of 2.1 (95% CI: 1.6-2.8). Conclusion: Our results indicate that OCHA resuscitation with an intact chain of survival occurs in approximately 1/3 of cases, and results in over a two-fold increase in the odds of surviving to hospital discharge. Initiatives to improve EMS teamwork and increase the proportion of OHCA resuscitation with an intact chain of survival appear to be warranted.

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