Abstract 253: Trajectory of Ventricular Fibrillation Prognostic Status During Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jason Coult ◽  
Shiv Bhandari ◽  
Diya Sashidhar ◽  
Thomas Rea ◽  
Jennifer E Blackwood ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Time Dependent ◽  
Probability Of Survival ◽  
Predicted Probability ◽  
Myocardial Energetics ◽  
Rhythm Analysis ◽  
Initial Shock ◽  
Hospital Cardiac Arrest

Background: Resuscitation from out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) typically involves continuous CPR cycles interrupted every 2 minutes for rhythm analysis and potential defibrillation. Quantitative measures of the VF ECG waveform have been proposed to guide therapy for VF arrest because they are associated with myocardial energetics, are dynamic over the course of resuscitation, and predict outcome. However, while VF waveform measures have until recently have required CPR interruption to accurately gauge prognostic status, CPR interruptions are associated with a lower chance of survival. We used a novel waveform measure previously-validated during active CPR to estimate the course of VF status through the 2-minute CPR cycle between consecutive shocks. Methods: We conducted an observational study of patients with VF OHCA who experienced recurrent VF for at least 90 seconds following initial shock. We used the continuous defibrillator ECG to calculate the VF waveform measure as a function of predicted probability of survival-with-intact-neurologic-status at 1-s intervals over the course of resuscitation between shocks. Results: We collected 499 VF ECG segments (≥90 seconds) during CPR from 313 patients. The trajectory of the average prognostic VF measure had a 3-phase time-dependent pattern (Fig. 1). During CPR, the slope of the measure decreased during the initial 25 s of VF (slope = -12%/min) and was relatively flat during the subsequent 65-s interval of VF (slope = +1%/min). Furthermore, slope decreased sharply following the cessation of CPR for rhythm analysis, charge, and shock (slope = -23%/min). Conclusion: On average, a novel VF waveform measure assessed during the scheduled cycle of CPR and rhythm analysis between consecutive shocks was characterized by a period of decline, stabilization, and then decline. Whether these changes in VF status can be used to improve care for individual patients is uncertain.

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 Survival of pediatric patients after cardiopulmonary resuscitation for in-hospital cardiac arrest: a systematic review and meta-analysis

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Melaku Bimerew ◽  
Adam Wondmieneh ◽  
Getnet Gedefaw ◽  
Teshome Gebremeskel ◽  
Asmamaw Demis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Probability Of Survival ◽  
Pooled Prevalence ◽  
Hospital Cardiac Arrest

Abstract Background In-hospital cardiac arrest is a major public health issue. It is a serious condition; most probably end up with death within a few minutes even with corrective measures. However, cardiopulmonary resuscitation is expected to increase the probability of survival and prevent neurological disabilities in patients with cardiac arrest. Having a pooled prevalence of survival to hospital discharge after cardiopulmonary resuscitation is vital to develop strategies targeted to increase probability of survival among patients with cardiac arrest. Therefore, this systematic review and meta-analysis was aimed to assess the pooled prevalence of survival to hospital discharge among pediatric patients who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest. Methods PubMed, Google Scholar, and Cochrane review databases were searched. To have current (five-year) evidence, only studies published in 2016 to 2020 were included. The weighted inverse variance random-effects model at 95%CI was used to estimate the pooled prevalence of survival. Heterogeneity assessment, test of publication bias, and subgroup analyses were also employed accordingly. Results Twenty-five articles with a total sample size of 28,479 children were included in the final analysis. The pooled prevalence of survival to hospital discharge was found to be 46% (95% CI = 43.0–50.0%; I2 = 96.7%; p < 0.001). Based on subgroup analysis by “continent” and “income level”, lowest prevalence of pooled survival was observed in Asia (six studies; pooled survival =36.0% with 95% CI = 19.01–52.15%; I2 = 97.4%; p < 0.001) and in low and middle income countries (six studies, pooled survival = 34.0% with 95% CI = 17.0–51.0%, I2 = 97.67%, p < 0.001) respectively. Conclusion Although there was an extremely high heterogeneity among reported results (I2 = 96.7%), in this meta-analysis more than half of pediatric patients (54%) who underwent cardiopulmonary resuscitation for in-hospital cardiac arrest did not survived to hospital discharge. Therefore, developing further strategies and encouraging researches might be crucial.

scholarly journals Insights From the Ventricular Fibrillation Waveform Into the Mechanism of Survival Benefit From Bystander Cardiopulmonary Resuscitation

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Brooke Bessen ◽  
Jason Coult ◽  
Jennifer Blackwood ◽  
Cindy H. Hsu ◽  
Peter Kudenchuk ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Survival Benefit ◽  
Amplitude Spectrum ◽  
Peak Frequency ◽  
Spectrum Area ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background The mechanism by which bystander cardiopulmonary resuscitation (CPR) improves survival following out‐of‐hospital cardiac arrest is unclear. We hypothesized that ventricular fibrillation (VF) waveform measures, as surrogates of myocardial physiology, mediate the relationship between bystander CPR and survival. Methods and Results We performed a retrospective cohort study of adult, bystander‐witnessed patients with out‐of‐hospital cardiac arrest with an initial rhythm of VF who were treated by a metropolitan emergency medical services system from 2005 to 2018. Patient, resuscitation, and outcome variables were extracted from emergency medical services and hospital records. A total of 3 VF waveform measures (amplitude spectrum area, peak frequency, and median peak amplitude) were computed from a 3‐second ECG segment before the initial shock. Multivariable logistic regression estimated the association between bystander CPR and survival to hospital discharge adjusted for Utstein elements. Causal mediation analysis quantified the proportion of survival benefit that was mediated by each VF waveform measure. Of 1069 patients, survival to hospital discharge was significantly higher among the 814 patients who received bystander CPR than those who did not (0.52 versus 0.43, respectively; P <0.01). The multivariable‐adjusted odds ratio for bystander CPR and survival was 1.6 (95% CI, 1.2, 2.1), and each VF waveform measure attenuated this association. Depending on the specific waveform measure, the proportion of mediation varied: 53% for amplitude spectrum area, 31% for peak frequency, and 29% for median peak amplitude. Conclusions Bystander CPR correlated with more robust initial VF waveform measures, which in turn mediated up to one‐half of the survival benefit associated with bystander CPR. These results provide insight into the biological mechanism of bystander CPR in VF out‐of‐hospital cardiac arrest.

Abstract 11816: Sustained Ventricular Fibrillation During CPR as the Strongest Predictor for the Favorable Neurological Outcomes in Out-of-hospital Cardiac Arrest Patients; The Multicenter Prospective Study of SAVE-J

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takahiro Nakashima ◽  
Yoshio Tahara ◽  
Satoshi Yasuda ◽  
Naoto Morimura ◽  
Ken Nagao ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Initial Rhythm ◽  
Group A ◽  
Group B ◽  
Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be effective in out-of-hospital cardiac arrest (OHCA) patients in whom ventricular fibrillation (VF) as an initial rhythm were refractory to conventional cardiopulmonary resuscitation (CPR). However, it remains unclear whether ECPR is effective even though cardiac rhythm would change from VF to non-VF during CPR. Methods: This multicenter prospective observational study was conducted in 46 hospitals. A total of 457 patients with OHCA aged 20-74 years in whom initial rhythm was VF and the duration from collapse to hospital arrival was within 45 minutes were originally registered. After given CPR for more than 15 minutes in hospital, these patients received combination therapy with ECPR including therapeutic hypothermia (TH), or not received. The patients underwent ECPR (n=250) were classified into the following 2 groups according to rhythm changes during CPR; Group-A (sustained VF; n=127) and Group-B (changing from VF initially to non-shockable rhythm; n=123). The endpoint was a favorable outcome defined as Cerebral Performance Category 1-2 at 6 months after collapse. Results: There were no significant differences of age, sex, time from collapse to ECPR start and the rate of TH between the 2 groups. The rate achieving favorable outcome was significantly higher in Group-A than Group-B. (19.7% vs. 3.3%, p<0.001) (Figure1). When focusing on sustained VF (Group-A), the rate achieving favorable outcome improved about 5.5-fold by ECPR (ECPR, n=127; 19.7% vs. non-ECPR, n=55; 3.6%, p<0.001) (Figure2). In the multivariate logistic-regression analysis, sustained VF during CPR was the strongest predictor for the favorable outcomes among the pre-hospital parameters including age, bystander CPR and time from collapse to ECPR (Odds ratio 4.43, p=0.018). Conclusions: These findings indicates that the patients with sustained VF seem to be a particular population that could merit ECPR.

scholarly journals Fuzzy and Sample Entropies as Predictors of Patient Survival Using Short Ventricular Fibrillation Recordings during out of Hospital Cardiac Arrest

Entropy ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 591 ◽  
Author(s):  
Beatriz Chicote ◽  
Unai Irusta ◽  
Elisabete Aramendi ◽  
Raúl Alcaraz ◽  
José Rieta ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Prediction Accuracy ◽  
Patient Survival ◽  
Myocardial Damage ◽  
Sample Entropy ◽  
Waveform Analysis ◽  
Embedding Dimension ◽  
Hospital Cardiac Arrest

Optimal defibrillation timing guided by ventricular fibrillation (VF) waveform analysis would contribute to improved survival of out-of-hospital cardiac arrest (OHCA) patients by minimizing myocardial damage caused by futile defibrillation shocks and minimizing interruptions to cardiopulmonary resuscitation. Recently, fuzzy entropy (FuzzyEn) tailored to jointly measure VF amplitude and regularity has been shown to be an efficient defibrillation success predictor. In this study, 734 shocks from 296 OHCA patients (50 survivors) were analyzed, and the embedding dimension (m) and matching tolerance (r) for FuzzyEn and sample entropy (SampEn) were adjusted to predict defibrillation success and patient survival. Entropies were significantly larger in successful shocks and in survivors, and when compared to the available methods, FuzzyEn presented the best prediction results, marginally outperforming SampEn. The sensitivity and specificity of FuzzyEn were 83.3% and 76.7% when predicting defibrillation success, and 83.7% and 73.5% for patient survival. Sensitivities and specificities were two points above those of the best available methods, and the prediction accuracy was kept even for VF intervals as short as 2s. These results suggest that FuzzyEn and SampEn may be promising tools for optimizing the defibrillation time and predicting patient survival in OHCA patients presenting VF.

scholarly journals Extracorporeal Cardiopulmonary Resuscitation for Management of Out-of-Hospital Cardiac Arrest in a Patient with Fulminant Myocarditis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Alexander J. Meyer ◽  
Michael A. Biersmith ◽  
Ernest L. Mazzaferri ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Acute Myocarditis ◽  
Fulminant Myocarditis ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Cardiac Catheterization Laboratory ◽  
Va Ecmo ◽  
Hospital Cardiac Arrest

A 68-year-old male with a witnessed out-of-hospital cardiac arrest while jogging who was managed with extracorporeal cardiopulmonary resuscitation (ECPR) is presented. The patient was found to be in refractory ventricular fibrillation by emergency medical service personnel and underwent advanced cardiac life support (ACLS) protocol with placement of an automated chest compression device. He was emergently transported to the cardiac catheterization laboratory. Due to refractory ventricular fibrillation, he was placed on venoarterial extracorporeal membranous oxygenation (VA-ECMO). Coronary angiography at that time showed nonobstructive coronary artery disease. Management with VA-ECMO and other supportive measures were continued for 5 days, after which a cardiac magnetic resonance imaging was performed with findings consistent with acute myocarditis. His condition substantially improved, and he was discharged from the hospital with good neurologic and functional status. Fulminant myocarditis is often fatal, but aggressive supportive measures with novel ECPR protocols may result in recovery, as it happened in this case.

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