Abstract 310: Validation of the Cardiac Arrest Hospital Prognosis (CAHP) Score in an American Out-of-hospital Cardiac Arrest Cohort: Results From a Large Single Center Cardiac Arrest Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jason J Grady ◽  
Katie A Atwell ◽  
Tomo Oshimura ◽  
Nima Ghasemzadeh
Keyword(s):  
Cardiac Arrest ◽  
Medical Center ◽  
Cerebral Performance Category ◽  
Serum Lactate ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Single Center ◽  
Neurologic Outcomes ◽  
Increased Risk ◽  
Hospital Cardiac Arrest

Background: The cardiac arrest hospital prognosis (CAHP) score has been shown in French studies to predict neurologic outcomes in patients who suffer an out-of-hospital cardiac arrest (OHCA), but this score has not been studied in an American cohort. We aimed to validate the CAHP score in an independent, single center, large cardiac arrest registry. Methods: Between January 2015 to June 2020 there were 925 patients who suffered OHCA and were transferred to Northeast Georgia Medical Center out of whom 450 patients survived to hospital admission. Cerebral Performance Category (CPC) score was used for assessment of neurologic outcome at discharge ranging from 1-5. The primary endpoint was poor neurologic outcome defined as CPC 3-5. Logistic regression was performed to identify independent predictors of poor neurologic outcome. Results: Included patients were mostly male 57% (256 of 450) with a mean age of 52±15. STEMI was present on 11% (51 of 450) and a shockable rhythm on 35% (150 of 450) of patients. Targeted temperature management (TTM) and a mechanical compression device (MCD) were used in 72% (327 of 450) and 74% (336 of 450) respectively. 76% (344 of 450) had a CPC of 3-5 at discharge. After adjusting for covariates, including gender, BMI, serum lactate level, witnessed arrest status, STEMI on ECG, and use of MCD and TTM, the only independent predictors of a CPC of 3-5 were CAHP score (p<0.001), witnessed cardiac arrest, (p=0.039, OR: 0.45) and STEMI on admission ECG (P=0.001, OR: 0.22). Compared with CAHP< 150, CAHP 150-200 and CAHP>200 were associated with a 12-fold (p<0.00001) and 79-fold (p<0.00001) increased risk of poor neurologic outcome. Area under ROC curve for CAHP score predicting neurologic outcome was 0.92 (95% CI: 0.89-0.94). Conclusion: Here we show, for the first time, in an independent, large American cardiac arrest registry that CAHP score predicts neurologic outcomes in patients with OHCA. Further research is needed to assess how this prognostication tool would help clinicians decide on early vs. delayed invasive strategy in patients with OHCA admitted to hospitals across the U.S.

scholarly journals Fever After Rewarming

2013 ◽  
Vol 29 (6) ◽  
pp. 365-369 ◽  
Author(s):  
Michael N. Cocchi ◽  
Myles D. Boone ◽  
Brandon Giberson ◽  
Tyler Giberson ◽  
Emily Farrell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Core Body Temperature ◽  
Cerebral Performance Category ◽  
Standard Of Care ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Neurologic Outcomes

Background: Induction of mild therapeutic hypothermia (TH; temperature 32-34°C) has become standard of care in many hospitals for comatose survivors of cardiac arrest. Pyrexia, or fever, is known to be detrimental in patients with neurologic injuries such as stroke or trauma. The incidence of pyrexia in the postrewarming phase of TH is unknown. We attempted to determine the incidence of fever after TH and hypothesized that those patients who were febrile after rewarming would have worse clinical outcomes than those who maintained normothermia in the postrewarming period. Methods: Retrospective data analysis of survivors of out-of-hospital cardiac arrest (OHCA) over a period of 29 months (December 2007 to April 2010). Inclusion criteria: OHCA, age >18, return of spontaneous circulation, and treatment with TH. Exclusion criteria: traumatic arrest and pregnancy. Data collected included age, sex, neurologic outcome, mortality, and whether the patient developed fever (temperature > 100.4°F, 38°C) within 24 hours after being fully rewarmed to a normal core body temperature after TH. We used simple descriptive statistics and Fisher exact test to report our findings. Results: A total of 149 patients were identified; of these, 82 (55%) underwent TH. The mean age of the TH cohort was 66 years, and 28 (31%) were female. In all, 54 patients survived for >24 hours after rewarming and were included in the analysis. Among the analyzed cohort, 28 (52%) of 54 developed fever within 24 hours after being rewarmed. Outcome measures included in-hospital mortality as well as neurologic outcome as defined by a dichotomized Cerebral Performance Category (CPC) score. When comparing neurologic outcomes between the groups, 16 (57%) of 28 in the postrewarming fever group had a poor outcome (CPC score 3-5), while 15 (58%) of 26 in the no-fever group had a favorable outcome ( P = .62). In the fever group, 15 (52%) of 28 died, while in the no-fever group, 14 (54%) of 26 died ( P = .62). Conclusion: Among a cohort of patients who underwent mild TH after OHCA, more than half of these patients developed pyrexia in the first 24 hours after rewarming. Although there were no significant differences in outcomes between febrile and nonfebrile patients identified in this study, these findings should be further evaluated in a larger cohort. Future investigations may be needed to determine whether postrewarming temperature management will improve the outcomes in this population.

scholarly journals Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

2020 ◽  
Author(s):  
Taeyoung Kong ◽  
Hye Sun Lee ◽  
Soyoung Jeon ◽  
Jong Wook Lee ◽  
Hyun Soo Chung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Thrombotic Microangiopathy ◽  
Morphological Characteristics ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Outcomes ◽  
Measured Time ◽  
Automated Hematology Analyzer ◽  
Hospital Cardiac Arrest

Abstract Background: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be quickly and serially measured without additional effort or costs. This study aimed to investigate whether the serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Methods:We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed the TMA score at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurologic outcome at discharge and 30-day mortality. Results:Increased TMA scores at all measured time points were independent predictors of poor neurologic outcomes and 30-day mortality, with the TMA score at time-12 showing the strongest correlation (OR, 3.008; 95% CI, 1.707–5.3; p=0.001 and HR, 1.517; 95% CI, 1.196–1.925; p=0.001.Specifically, TMA score ≥2 at time-12 was closely associated with increased predictability of poor neurologic outcome (OR, 6.302; 95% CI: 2.841–13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI: 1.675–4.211; p<0.001).Conclusions: Increased TMA scores predicted the neurologic outcome and 30-day mortalityin patients undergoing TTM after OHCA. In addition to the benefit of being quickly and serially measured by using an automated hematology analyzer without additional effort or costs, this finding indicates that the TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with ROSC after OHCA.

scholarly journals Growth differentiation factor 15 and early prognosis after out-of-hospital cardiac arrest

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Ferran Rueda ◽  
Germán Cediel ◽  
Cosme García-García ◽  
Júlia Aranyó ◽  
Marta González-Lopera ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tissue Injury ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Home Setting ◽  
Growth Differentiation Factor 15 ◽  
Poor Outcome ◽  
Differentiation Factor ◽  
Hospital Cardiac Arrest ◽  
Early Predictor

Abstract Background Growth differentiation factor 15 (GDF-15) is an inflammatory cytokine released in response to tissue injury. It has prognostic value in cardiovascular diseases and other acute and chronic conditions. Here, we explored the value of GDF-15 as an early predictor of neurologic outcome after an out-of-hospital cardiac arrest (OHCA). Methods Prospective registry study of patients in coma after an OHCA, admitted in the intensive cardiac care unit from a single university center. Serum levels of GDF-15 were measured on admission. Neurologic status was evaluated according to the cerebral performance category (CPC) scale. The relationship between GDF-15 levels and poor neurologic outcome at 6 months was analyzed. Results Among 62 patients included, 32 (51.6%) presented poor outcome (CPC 3–5). Patients with CPC 3–5 exhibited significantly higher GDF-15 levels (median, 17.1 [IQR, 11.1–20.4] ng/mL) compared to those with CPC 1–2 (7.6 [IQR, 4.1–13.1] ng/mL; p = 0.004). Multivariable logistic regression analyses showed that age (OR, 1.09; 95% CI 1.01–1.17; p = 0.020), home setting arrest (OR, 8.07; 95% CI 1.61–40.42; p = 0.011), no bystander cardiopulmonary resuscitation (OR, 7.91; 95% CI 1.84–34.01; p = 0.005), and GDF-15 levels (OR, 3.74; 95% CI 1.32–10.60; p = 0.013) were independent predictors of poor outcome. The addition of GDF-15 in a dichotomous manner (≥ 10.8 vs. < 10.8 ng/mL) to the resulting clinical model improved discrimination; it increased the area under the curve from 0.867 to 0.917, and the associated continuous net reclassification improvement was 0.90 (95% CI 0.48–1.44), which allowed reclassification of 37.1% of patients. Conclusions After an OHCA, increased GDF-15 levels were an independent, early predictor of poor neurologic outcome. Furthermore, when added to the most common clinical factors, GDF-15 improved discrimination and allowed patient reclassification.

Abstract 407: Utility of Abnormal Head Computed Tomography in Predicting Outcome in Out of Hospital Cardiac Arrest Victims Resuscitated and Subsequently Placed on Targeted Temperature Management

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Michael Bernett ◽  
Robert A Swor
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Survival Analysis ◽  
Interrater Reliability ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Radiology Reports ◽  
Head Computed Tomography ◽  
Hospital Cardiac Arrest

Introduction: Head computed tomography (HCT) is often performed to assess for hypoxic-ischemic brain injury in resuscitated out of hospital cardiac arrest (OHCA) patients. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome post OHCA. Methods: We included subjects from a prospectively collected cardiac arrest database of OHCA adult patients who received targeted temperature management (TTM) at two academic suburban hospitals from 2009-Sept-2018. Cases were included if a HCT was performed in the emergency department (ED). Patient demographics and cardiac arrest variables were collected. HCT results were abstracted by study authors from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, stroke). Outcomes were survival to discharge or cerebral performance scores (CPC) at discharge of three or four (poor neurologic outcome). Descriptive statistics, univariate, multivariate, survival, and interrater reliability analysis were performed. Results: During the study period, there were 425 OHCA, 277 cases had ED HCTs performed; 254 cases were included in the final survival analysis. Patients were predominately male, 189 (65.0%), average age 60.9 years, average BMI of 30.5. Of all cases, 44 (15.9%) showed CE on CT. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (OR: 9.23; 95% CI 1.73, 49.2), and 9.1-fold greater odds of death (OR: 9.09: 95% CI 2.4 33.9). In adjusted analysis, CE was associated with 14.9-fold greater odds of poor CPC outcome (AOR: 14.9, 95% CI, 2.49, 88.4), and 13.7-fold greater odds of death (AOR: 13.7, 95% CI, 3.26, 57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (HR: 3.56: 95% CI 2.34, 5.41). Interrater reliability demonstrated excellent agreement between reviewers for CE on HCT (κ = 0.86). Conclusion: The results identify that abnormal HCTs early in the post-arrest period in OHCA patients are associated with poor rates of survival and neurologic outcome. Prospective work is needed to confirm whether selection bias or other variables confound this association.

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.

scholarly journals Promising candidates for extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yo Sep Shin ◽  
Youn-Jung Kim ◽  
Seung Mok Ryoo ◽  
Chang Hwan Sohn ◽  
Shin Ahn ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Low Flow ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurologic Status ◽  
Good Neurologic Outcome ◽  
Hospital Stays ◽  
Hospital Cardiac Arrest

AbstractPrecise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.

Abstract 01: The Importance of Time to Cooling in Out-Of-Hospital Cardiac Arrest Patients to Influence Neurologically Intact Survival: A Sub-Analysis of the Princess Trial

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Akil Awad ◽  
Fabio Silvio Taccone ◽  
Martin Jonsson ◽  
Sune Forsberg ◽  
Jacob Hollenberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Secondary Outcome ◽  
Control Group ◽  
Shockable Rhythm ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Background: Early initiation of hypothermia has shown to be important to reduce brain injuries in experimental cardiac arrest models. The aim of this study was to investigate the association between time to initiate cooling and neurological intact survival in patients with out-of-hospital cardiac arrest (OHCA). Methods: A secondary analysis of prospectively collected data from the PRINCESS trial (NCT01400373) including 677 OHCA patients randomized to transnasal evaporative intra-arrest cooling or standard advanced life support and cooling started subsequent to hospital arrival. Time to randomization was used a proxy measurement for time to initiate cooling. An early treatment group was defined as patients randomized by the EMS <20 minutes from the time of the cardiac arrest. Propensity scores were used to find matching patients in the control group. Patients with initial shockable rhythms were analyzed as a predefined subgroup. The primary outcome was good neurologic outcome, Cerebral Performance Category (CPC) 1-2 at 90 days. Secondary outcome was complete recovery (CPC 1). Results: In total 406 patients were randomized <20 minutes from the cardiac arrest and were propensity score matched (1:1). In the propensity score matched analysis the proportion of patients with CPC 1-2 was 21.7% in the intervention and 17.2% in the control group, odds ratio (OR) 1.33, 95% confidence interval (CI) 0.80-2.21, p=0.273. In patients with initial shockable rhythm (79 intervention, 79 control) the difference in CPC 1-2 was 48.1% versus 32.0%, OR 2.05, 95%CI 1.00-4.21, p=0.0498. The proportion of patients with complete neurologic recovery, CPC 1, was 19.7% in the intervention and 13.3% in the control group, OR 1.60, 95% CI 0.92-2.79, p=0.097. In patients with initial shockable rhythm the proportion with CPC 1 was 45.6% versus 24.6%, OR 2.81, 95% CI 1.23-6.42, p=0.014. Conclusions: In this ancillary study of OHCA patients receiving intra-arrest cooling, there were differences in survival with good neurologic outcome and in complete neurological recovery in favor of early intra-arrest cooling patient group compared to standard care. These differences were statistically significant in the subgroup of patients with initial shockable rhythms.

Abstract 307: The Value of Intracranial Pressure Measurement via Lumbar Puncture as an Early Prognostic Predictor in Cardiac Arrest Patients Treated With Targeted Temperature Management

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Yeonho You ◽  
Jung Soo Park ◽  
Jin Hong Min
Keyword(s):  
Cardiac Arrest ◽  
Lumbar Puncture ◽  
Brain Injuries ◽  
Roc Curves ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Significance Level ◽  
Poor Outcome ◽  
Neurologic Outcomes ◽  
Outcome Group

Introduction: We evaluated prognostic value of ICP measurement via lumbar puncture to predict outcome of cardiac arrest patients treated with TTM Methods: This was a single-center observational cohort study using paper sheets of patients from October 2012 to June 2017. The primary endpoint was the ability of the early ICP measurement to predict poor outcome within 24 h after cardiac arrest, compared to ONSD and GWR. Based on previous studies, 32 patients were needed to achieve the power of 0.90 at a significance level of 0.05. The ROC curves was used to compare the values of ONSD, GWR and ICP for predicting neurologic outcomes. Results were considered significant at P < 0.05. Results: 103 patients were enrolled and good outcome group had 31 patients, while poor outcome group had 72 patients. The AUROC of ONSD and GWR were 0.64(0.54-0.73) and 0.63 (0.53-0.72) respectively in predicting poor neurologic outcome while the AUROC of ICP was 0.97(0.92-0.99) in predicting poor neurologic outcome (Fig. 2). As the cut off value of ICP was 200 mmH 2 O, sensitivity was 87.50% and specificity was 100.00% in predicting poor neurologic outcome. In ONSD, sensitivity was 78.43% and specificity was 41.86% in predicting poor neurologic outcome when cut off value was 5.50 mm. As the cut off value of GWR was 1.16, sensitivity was 59.72% and specificity was 74.19% in predicting poor neurologic outcome. Conclusion: In this study, we confirms that ICP measurement via lumbar puncture within the first 24 h after cardiac arrest is a valuable tool to evaluate the severity of post-cardiac arrest brain injuries and outcome in patients treated with TTM.

scholarly journals Early Post-Rewarming Fever Is Associated with Favorable 6-Month Neurologic Outcomes in Patients with Out-Of-Hospital Cardiac Arrest: A Multicenter Registry Study

2020 ◽  
Vol 9 (9) ◽  
pp. 2927
Author(s):  
Hyoung Youn Lee ◽  
Dong Hun Lee ◽  
Byung Kook Lee ◽  
Kyung Woon Jeung ◽  
Yong Hun Jung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Multicenter Study ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Temperature Management ◽  
Registry Study ◽  
Neurologic Outcomes ◽  
Hospital Cardiac Arrest ◽  
Multicenter Registry

We investigated the association between post-rewarming fever (PRF) and 6-month neurologic outcomes in cardiac arrest survivors. This was a multicenter study based on a registry of comatose adult (³ 18years) out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management between October 2015 to December 2018. PRF was defined as peak temperature ≥ 38.0 °C within 72 h after completion of rewarming, and PRF timing was categorized as within 24, 24–48, and 48–72 h epochs. The primary outcome was neurologic outcomes at six months after cardiac arrest. Unfavorable neurologic outcome was defined as cerebral performance categories three to five. A total of 1031 patients were included, and 642 (62.3%) had unfavorable neurologic outcomes. PRF developed in 389 (37.7%) patients in 72 h after rewarming: within 24 h in 150 (38.6%), in 24–48 h in 155 (39.8%), and in 48–72 h in 84 (21.6%). PRF was associated with improved neurologic outcomes (odds ratio (OR), 0.633; 95% confidence interval (CI), 0.416–0.963). PRF within 24 h (OR, 0.355; 95% CI, 0.191–0.659), but not in 24–48 h or 48–72 h, was associated with unfavorable neurologic outcomes. Early PRF within 24 h after rewarming was associated with favorable neurologic outcomes.

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