Abstract 290: The Association of Regional Intra-arrest Transport Practices for Out-of-hospital Cardiac Arrest with Survival and Neurological Status at Hospital Discharge

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Brian E Grunau ◽  
Takahisa Kawano ◽  
Masashi Okubo ◽  
Joshua Reynolds ◽  
Matthieu Heidet ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Patient Outcomes ◽  
Patient Survival ◽  
Secondary Analysis ◽  
Neurological Status ◽  
Spontaneous Circulation ◽  
Regional Level ◽  
Regional Clusters ◽  
Hospital Cardiac Arrest

Background: There is substantial regional variation in out-of-hospital cardiac arrest (OHCA) outcomes. We investigated whether regional-level intra-arrest transport practices were associated with patient outcomes. Methods: We performed a secondary analysis of the “CCC Trial” dataset, which included EMS-treated adult non-traumatic OHCA enrolled from 49 regional clusters. The exposure of interest was regional-level intra-arrest transport practices (RIATP), calculated as the proportion of cases within the enrolling cluster transported prior to return of spontaneous circulation (“intra-arrest transport”), divided into quartiles. We fit a multilevel mixed-effects logistic regression model to estimate the association of RIATP quartile and both survival and favorable neurologic status (mRS ≤ 3) at hospital discharge, adjusted for patient-level Utstein variables. Results: We included all 26,148 CCC-enrolled patients, 36% of whom were female, 97% were treated with prehospital ALS, and 23% had shockable initial rhythms. The median RIATP of the 49 clusters was 20% (IQR 6.2 - 30%). The figure shows outcomes stratified by RIATP quartile. Compared to the first quartile (<6.2%), increasing RIATP had the following adjusted associations with: (i) favourable neurological status: OR 0.87 (95% CI 0.60-1.26), 0.74 (95% CI 0.51-1.07), 0.36 (95% CI 0.25-0.53); and (ii) survival: 0.63 (95% CI 0.47-0.85), 0.60 (95% CI 0.45-0.79), 0.44 (95% CI 0.33-0.59). Conclusion: Treatment within a region that utilizes intra-arrest transport less frequently was associated with improved patient survival. These results may, in part, explain differences between regional OHCA survival outcomes.

Abstract 258: Adherence to the Transport Recommendations in the Universal Termination of Resuscitation Rule and Survival After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Masashi Okubo ◽  
David J Wallace ◽  
Brian E Grunau ◽  
Mohamud R Daya ◽  
Clifton W Callaway
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Median Proportion ◽  
Large Cohort Study ◽  
Hospital Cardiac Arrest

Introduction: Survival after out-of-hospital cardiac arrest (OHCA) varies across emergency medical services (EMS) systems. The contribution of EMS practices variation on the outcome disparities is unclear. We evaluated the association between EMS agency variation in adherence to the transport recommendations in the Universal Termination of Resuscitation (TOR) Rule and survival after OHCA. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epistry. We included adults (≥ 18 years) with OHCA for whom EMS providers attempted resuscitation from 2011 through 2015. The main exposure was the proportion of patients for whom the Universal TOR Rule recommended transport (i.e., meeting any one of the following criteria, EMS-witnessed arrest; return of spontaneous circulation prior to transport; or shock delivery prior to transport) among those transported to hospitals, at the level of EMS agency. We then categorized EMS agencies into quartiles. Our primary outcome was survival to hospital discharge. We used multilevel modified Poisson regression model, including patient-level and EMS-level covariates with patients nested within EMS agencies. Results: We included 42,584 EMS-treated OHCAs from 112 EMS agencies. The median proportion of patients for whom the TOR rule recommended transport among those transported was 88.2% (interquartile range [IQR] 76.1-96.7) across EMS agencies. Compared with the patients treated at EMS agencies in the quartile of the lowest proportion (the median proportion 66.7%[ IQR 50.9-71.7]), survival to hospital discharge was associated with treatment at EMS agencies in the second quartile (the median proportion 83.0% [IQR 79.8-85.3]) (adjusted risk ratio [aRR] 1.12, 95% confidence interval [CI] 0.96-1.31), the third quartile (the median proportion 93.0% [IQR 89.7-95.6]) (aRR 1.58, 95% CI 1.32-1.87), and the fourth quartile (the median proportion 100% [IQR 98.5-100]) (aRR 1.86, 95% CI 1.59-2.19). Conclusions: In this large cohort study of adult patients with OHCA, treatment at EMS agencies with higher proportion of patients who met transport criteria of the Universal TOR rule among transported patients was associated with survival to hospital discharge.

Abstract 10559: Association of Intra-Arrest Transport versus Continued On-scene Resuscitation with Survival to Hospital Discharge Among Pediatric Patients with Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Masashi Okubo ◽  
Sho Komukai ◽  
Junichi Izawa ◽  
Ian Drennan ◽  
Brian Grunau ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Spontaneous Circulation ◽  
Time Dependent ◽  
Matched Cohort ◽  
Return Of Spontaneous Circulation ◽  
Patient Demographics ◽  
Hospital Cardiac Arrest

Introduction: For pediatric patients with out-of-hospital cardiac arrest (OHCA) who do not achieve return of spontaneous circulation (ROSC), it remains unclear whether patients should be transported to a hospital with ongoing resuscitation or remain on-scene for further resuscitation. We therefore evaluated: (1) the association between intra-arrest transport, with reference to continued on-scene resuscitation, and survival to hospital discharge; and, (2) whether the association differs across the timing of intra-arrest transport. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epidemiologic Registry. We included pediatrics (<18 years) with emergency medical services (EMS)-treated OHCA between 2005 and 2015. Our exposure of interest was intra-arrest transport, defined as transport to a hospital prior to ROSC. Patients who had intra-arrest transport at any minute after EMS arrival underwent risk-set matching with patients who had continued on-scene resuscitation within the same minute using time-dependent propensity score calculated from patient demographics, arrest characteristics, and EMS interventions. We repeated the main analysis with 5-minute strata by the time of matching. Results: Of 2,854 included patients, the median age was 1 year (IQR, 0-9), 59.3% were male, 9.8% were public location, 22.1% were bystander witnessed, 6.0% had initial shockable rhythms, and 66.3% underwent intra-arrest transport at a median of 15 minutes (IQR 9-22) after EMS arrival. In the propensity-matched cohort including 2,080 patients, 5.5 % (57/1040) in intra-arrest transport group and 5.9% (61/1040) in continued on-scene resuscitation group had survival to hospital discharge (risk ratio [RR]=0.94, 95% CI 0.65-1.37). We did not detect an association within the time-based strata: 0-5 minutes (RR=0.74, 95% CI 0.19-2.85), 5-10 minutes (RR=0.52, 95% CI 0.23-1.16), 10-15 minutes (RR=1.13, 95% CI 0.58-2.22), 15-20 minutes, (RR=1.70, 95% CI 0.78-3.71), or >20 minutes (RR=0.73, 95% CI 0.32-1.63) after EMS arrival. Conclusions: Among pediatric patients with OHCA, intra-arrest transport was not associated with survival to hospital discharge. The findings persisted across the timing of intra-arrest transport.

Abstract 257: Adherence to the Termination Recommendations in the Universal Termination of Resuscitation Rule and Survival After Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Masashi Okubo ◽  
David J Wallace ◽  
Brian E Grunau ◽  
Mohamud R Daya ◽  
Clifton W Callaway
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Large Cohort Study ◽  
Fourth Quartile ◽  
Hospital Cardiac Arrest

Introduction: Survival after out-of-hospital cardiac arrest (OHCA) varies across emergency medical services (EMS) systems, but the EMS practices that contribute to the outcome variation are unclear. We evaluated the association between EMS agency variation in adherence to the termination recommendations in the Universal Termination of Resuscitation (TOR) rule and survival after OHCA. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epistry, a prospective multicenter OHCA registry in North America. We included adults (≥ 18 years) with OHCA for whom EMS providers attempted resuscitation from 2011 through 2015. The main exposure was proportion of patients meeting the Universal TOR rule (not EMS-witnessed arrest, no return of spontaneous circulation prior to transport, and no shock delivery prior to transport) among those who had prehospital TOR at the level of EMS agency. We categorized EMS agencies into quartiles based on the adherence to the Universal TOR rule. Our primary outcome was survival to hospital discharge. We used multilevel modified Poisson regression model, including patient-level and EMS-level covariates with patients nested within EMS agencies. Results: We included 43,656 EMS-treated OHCAs from 112 EMS agencies. The median adherence to the Universal TOR rule was 75.6% (interquartile range [IQR] 67.5-83.7) across EMS agencies. Compared with patients resuscitated at EMS agencies in the quartile of the lowest adherence (median adherence 62.5% [IQR 58.9-65.7]), survival to hospital discharge was inversely associated with treatment at EMS agencies in the second quartile (median adherence 72.6% [IQR 70.2-74.7]) (adjusted risk ratio [aRR] 0.83, 95% confidence interval [CI] 0.71-0.96), the third quartile (median adherence 80.6% [IQR 78.5-81.9]) (aRR 0.71, 95% CI 0.60-0.85), and the fourth quartile (median adherence 90.6% [IQR 86.2-93.7]) (aRR 0.68, 95% CI 0.58-0.80). Conclusions: In this large cohort study of adult patients with OHCA, we observed variation in the adherence to the Universal TOR rule’s termination recommendations across EMS agencies, and an association between higher EMS-level adherence and worse survival to hospital discharge after OHCA.

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.

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

Circulation ◽  
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.

Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Lars W Andersen ◽  
Katherine Berg ◽  
Brian Z Saindon ◽  
Joseph M Massaro ◽  
Tia T Raymond ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
National Registry ◽  
Epinephrine Administration ◽  
Negatively Associated ◽  
Logistic Regression Models ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age < 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97], per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.

Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest

2020 ◽  
Vol 31 (4) ◽  
pp. 401-409
Author(s):  
Roberta Kaplow ◽  
Pam Cosper ◽  
Ray Snider ◽  
Martha Boudreau ◽  
John D. Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Patient Outcomes ◽  
Life Support ◽  
Patient Survival ◽  
Average Rate ◽  
Cardiopulmonary Arrest ◽  
Academic Medical Center ◽  
Convenience Sample ◽  
Resuscitation Guidelines ◽  
Hospital Cardiac Arrest

Background Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes. Objectives To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest. Methods An observational study was conducted using prospectively collected data from a convenience sample. Cardiopulmonary arrest forms and medical records were evaluated at an academic medical center. Adherence to resuscitation guidelines was measured with the ZOLL R Series monitor/defibrillator using RescueNet Code Review software. The primary outcome was patient survival. Results Of 200 cases, 37% of compressions were in the recommended range for rate (100-120/min) and 63.9% were in range for depth. The average rate was above target 55.7% of the time. The average depth was above and below target 1.4% and 34.7% of the time, respectively. Of the 200 patients, 125 (62.5%) attained return of spontaneous circulation. Of those, 94 (47%) were alive 24 hours after resuscitation. Fifty patients (25%) were discharged from the intensive care unit alive and 47 (23.5%) were discharged from the hospital alive. Conclusions These exploratory data reveal overall survival rates similar to those found in previous studies. The number of pauses greater than 10 seconds during resuscitation was the one consistent factor that impacted survival. Despite availability of an audiovisual feedback system, rescuers continue to perform compressions that are not at optimal rate and depth.

scholarly journals Survival and Long-term Outcomes Following in-hospital Cardiac Arrest in a Swiss University Hospital: a Prospective Observational Study

2021 ◽  
Author(s):  
Alexander Fuchs ◽  
Dominic Käser ◽  
Lorenz Theiler ◽  
Robert Greif ◽  
Jürgen Knapp ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Functional Status ◽  
Survival Rates ◽  
Neurological Status ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Return Of Spontaneous Circulation ◽  
Team Interventions ◽  
Hospital Cardiac Arrest ◽  
Cardiac Arrest Team

Abstract Background: Incidence of in-hospital cardiac arrest is reported to be 0.8 to 4.6 per 1,000 patient admissions. Patient survival to hospital discharge with favourable functional and neurological status is around 21%. The Bern University Hospital is a tertiary medical centre in Switzerland with a cardiac arrest team from the Department of Anaesthesiology and Pain Medicine that is available 24 h per day, 7 days per week. Due to lack of central documentation of cardiac arrest team interventions, the incidence, outcomes and survival rates of cardiac arrests are unknown. The aim was thus to record all cardiac arrest team interventions over 1 year, and to analyse the outcome and survival rates of adult patients after in-hospital cardiac arrests.Methods: We conducted a prospective single-centre observational study that recorded all adult in-hospital cardiac arrest team interventions over 1 year, using an Utstein-style case report form. The primary outcome was 30-day survival after in-hospital cardiac arrest. Secondary outcomes were return of spontaneous circulation, neurological status (after return of spontaneous circulation, after 24 h, after 30 days and 1 year), according to the Glasgow Outcomes Scale, and functional status at 30 days and 1 year, according to the Short-form-12 Health Survey.Results: The cardiac arrest team had 146 interventions over the study year, which included 60 non-life-threatening alarms (41.1%). The remaining 86 (58.9%) acute life-threatening situations included 68 (79.1%) as patients with cardiac arrest. The mean age of these cardiac arrest patients was 68 ±13 years, with a male predominance (51/68; 75.0%). Return of spontaneous circulation was recorded in 49 patients (72.1%). Over one-third of the cardiac arrest patients (27/68) were alive after 30 days with favourable neurological outcome. The patients who survived to 1 year after the event showed favourable neurological and functional status. Conclusions: The in-hospital cardiac arrest incidence on a large tertiary Swiss university hospital was 1.56 per 1,000 patient admissions. After a cardiac arrest, about a third of the patients survived to 1 year with favourable neurological and functional status. Early recognition and high-quality cardiopulmonary resuscitation provided by a well-organised team is crucial for patient survival.Trial Registration: The trial was registered in clinicaltrials.gov (NCT02746640).

scholarly journals The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (23) ◽  
pp. 5573
Author(s):  
Karol Bielski ◽  
Agnieszka Szarpak ◽  
Miłosz Jaroslaw Jaguszewski ◽  
Tomasz Kopiec ◽  
Jacek Smereka ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Meta Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Survival Outcomes ◽  
Cochrane Central Register ◽  
Mortality And Morbidity ◽  
Hospital Cardiac Arrest

Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06–1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37–1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1–2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35–2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13–2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.

Abstract 12258: Out-of-hospital Cardiac Arrest With Initially Shockable Rhythm: What Are the Outcomes if No Shock is Given?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yan Xiong ◽  
Ahamed H Idris
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Multiple Variable ◽  
Multiple Variable Regression ◽  
Hospital Cardiac Arrest ◽  
Resuscitation Attempt

Background: Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with a shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. Objectives: To describe demographics, pre-hospital characteristics, interventions, and outcomes in OHCA patients with an initially shockable rhythm who did and did not get shocked in the field in DFW ROC site. Methods: We included all non-traumatic OHCA cases ≥18 years old with VF or VT as first known rhythms, who were treated and transported to a hospital within the DFW ROC site between 2006 - 2011. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multiple variable regression analysis assessed the association between shock delivery and ROSC in the field as well as survival. Results: Included were 882 adult non-traumatic OHCA cases with VF or VT as first known rhythms; mean (±SD) age was 60 ± 15 years, 71% male, bystander witnessed 56%, bystander resuscitation attempt 43%, public arrest location 26%, EMS response time 4.7 ± 2.3 min, 26.9% (237) had ROSC in the field, 14.9% (131) survived to hospital discharge; 93.4% (824) of all patients were shocked, while 6.6% (58) were not shocked. Of the 6.6% (58) who were not shocked, 12.1% (7) achieved ROSC in the field and 8.6% (5) survived to hospital discharge. For those not shocked in the field, the unadjusted and adjusted odds ratios for ROSC were 0.354 (95% CI 0.158-0.791, p=0.011) and 0.189 (95% CI 0.039-0.911, p=0.038), respectively; and for survival to hospital discharge they were 0.522 (95% CI 0.205-1.331, p=0.173) and 0.498 (95% CI 0.088-2.810, p=0.430), respectively. Conclusions: In the DFW ROC site, 6.6% of OHCA victims with an initially shockable rhythm did not receive a shock, which was significantly associated with decreased ROSC in the field. More patients survived who were shocked in the field, but this difference was not significant after adjustment for Utstein variables.

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