Abstract 333: A Prospective Study of the Incidence of Intracranial Hemorrhage in Survivors of Out of Hospital Cardiac Arrest

Introduction: Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence. A single Japanese prospective study found a high incidence of ICH in survivors of OHCA (18.3% incidence), but that data is not generalizable to the US, which has a far lower overall rate of ICH. Aim: This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC). Methods: We prospectively analyzed all consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period from 2018-2020. A standardized order set, including non-contrast head computed-tomography (NCH-CT), was recommended as part of the initial management for all patients with ROSC after OHCA. Patient and cardiac arrest variables were recorded, as were NCH-CT findings. Results: During the study period, 194 patients presents to the emergency department with OHCA, and 95 patients achieved ROSC and survived to hospital admission. A NCH-CT was obtained in 85/95 patients (89.5%). Twenty-four of 85 patients (28.2%) survived to hospital discharge. Three of 85 patients with NCH-CT had ICH (3.5%). Survival with good neurologic outcome was seen in 14/82 (17.1%) patients without ICH and in 0/3 patients with ICH. Patients with ICH were significantly older than patients without ICH (86.7 years versus 64.4 years, p=0.01). Conclusions: In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission. The incidence of ICH in survivors of OHCA was 3.5%, lower than previously reported retrospective data in the US, and much lower than reported in a prospective Japanese study. No patients with ICH survived with good neurologic outcome.

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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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How many prehospital defibrillation attempts should be performed in out-of-hospital cardiac arrest patients with shockable rhythm?

10.21203/rs.3.rs-106512/v1 ◽

2020 ◽

Author(s):

Byuk Sung Ko ◽

Youn-Jung Kim ◽

Kap Su Han ◽

You Hwan Jo ◽

Jonghwan Shin ◽

...

Keyword(s):

Cardiac Arrest ◽

Odds Ratio ◽

Cerebral Performance Category ◽

Spontaneous Circulation ◽

Neurologic Outcome ◽

Secondary Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Shockable Rhythm ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

Abstract Background: Early defibrillation is vital to improve outcomes after out-of-hospital cardiac arrest (OHCA) with shockable rhythm. Currently, there is no agreed consensus on the number of defibrillation attempts before transfer to a hospital. This study aimed to evaluate the correlation between the number of defibrillations on the prehospital return of spontaneous circulation (ROSC).Methods: A multicenter, prospective, observational registry-based study was conducted for OHCA in patients with presumed cardiac etiology that underwent prehospital defibrillation between October 2015 and June 2017. The primary outcome was prehospital ROSC, and the secondary outcome was a good neurologic outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Results: Among 2,155 OHCA patients’ data, 178 patients with missing data were excluded, a total of 1,983 OHCA patients who received prehospital defibrillation were included. The median age was 61 years and prehospital ROSC was observed in 738 patients (37.2%). The median time from arrest to first defibrillation was 10 (interquartile range: 7-15) minutes. The cumulative ROSC rates and good neurologic outcome from the initial defibrillation to the sixth defibrillation were 43%, 68%, 81%, 90%, 95%, 98% and 42%, 66%, 81%, 90%, 95%, 98%, respectively. After clinical characteristics adjustment and time to defibrillation, the number of defibrillations were independently associated with ROSC (odds ratio 0.81 95% CI 0.76-0.86) and good neurologic outcome (odds ratio 0.86 95% CI 0.80-0.91). Moreover, subgroup analysis results with patients that underwent the initial defibrillation within 10 minutes from arrest were consistent (95% up to five times).Conclusion: More than 95% of prehospital ROSC was achieved within five times of defibrillation in OHCA patients. This result provides a basis for the ideal number of defibrillation attempts before transfer to hospital with the possibility of extracorporeal cardiopulmonary resuscitation in these refractory ventricular fibrillation patients.

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A prospective study of the incidence of intracranial hemorrhage in survivors of out of hospital cardiac arrest

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.12.015 ◽

2021 ◽

Vol 41 ◽

pp. 70-72

Author(s):

Jonathan Gelber ◽

Martha E. Montgomery ◽

Amandeep Singh

Keyword(s):

Cardiac Arrest ◽

Prospective Study ◽

Intracranial Hemorrhage ◽

A Prospective Study ◽

Hospital Cardiac Arrest

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Prognostic Value of the Conversion to a Shockable Rhythm in Out-of-Hospital Cardiac Arrest Patients with Initial Non-Shockable Rhythm

Journal of Clinical Medicine ◽

10.3390/jcm8050644 ◽

2019 ◽

Vol 8 (5) ◽

pp. 644 ◽

Cited By ~ 1

Author(s):

Kap Su Han ◽

Sung Woo Lee ◽

Eui Jung Lee ◽

Su Jin Kim

Keyword(s):

Cardiac Arrest ◽

Prognostic Value ◽

Primary Outcome ◽

Prognostic Significance ◽

Spontaneous Circulation ◽

Neurologic Outcome ◽

Shockable Rhythm ◽

Control And Prevention ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest

In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter “conversion”) during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. The primary outcome was good neurologic outcome at hospital discharge. Of 85,602 patients with an initial non-shockable rhythm, 17.9% experienced conversion. Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248–3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167–4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred.

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

Scientific Reports ◽

10.1038/s41598-020-79283-1 ◽

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.

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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 ◽

10.1161/circ.140.suppl_2.01 ◽

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.

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Abstract 260: Regional Routing for Extracorporeal Membrane Oxygenation to Increase Survival From Refractory Ventricular Fibrillation/Ventricular Tachycardia Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.142.suppl_4.260 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Nichole E Bosson ◽

Amy H Kaji ◽

James T Niemann ◽

Shira Schlesinger ◽

David Shavelle ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Extracorporeal Membrane Oxygenation ◽

Neurologic Outcome ◽

Transport Time ◽

Regional System ◽

Good Neurologic Outcome ◽

Hospital Cardiac Arrest ◽

Actual Survival

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly used to support patients with refractory ventricular fibrillation/ventricular tachycardia (rVF/VT) out-of-hospital cardiac arrest (OHCA). Los Angeles County (LAC) operates a regional system of care for 10.2 million persons, routing patients with OHCA to the closest cardiac receiving center. The purpose of this study was to determine 1) the number of patients eligible and 2) the potential for increased neurologically intact survival routing patients with rVF/VT OHCA to ECMO-capable cardiac centers. Methods: This was a retrospective study utilizing LAC quality improvement databases. Patients 18-75 years treated by EMS from 2011-2017 for rVF/VT OHCA, defined as persistent VF/VT after 3 defibrillations, were included in the analysis. Actual survival with good neurologic outcome, defined as cerebral performance category (CPC) 1 or 2, was abstracted from the LAC OHCA Registry. Theoretical patient outcome with routing directly to an ECMO-capable center was determined by applying outcomes as described by the Minnesota Resuscitation Consortium (MRC) for rVF/VT transported for ECMO. Assumptions included the availability of ECMO within a 30-minute transport time, and similar proportions of patients meeting criteria for transport/cannulation and surviving with CPC 1-2 as the MRC cohort, 78% and 40% respectively. For the remaining patients, we assumed no change in outcome. We compared the actual to the theoretical outcome with regional ECMO to determine the annual increase in survival with good neurologic outcome. Results: During the 7-year study period, there were 1862 patients with rVT/VT OHCA with outcomes available for 1454 (78%) patients. Median age was 59 years (IQR 51-66); 76% were male. Actual survival with CPC 1-2 was 13% (187 patients). Theoretical survival with CPC 1-2 in a regional ECMO-capable system was 34% (495 patients); OR 3.5 (95%CI 2.9-4.2), p<0.0001 with ECMO routing versus without. Conclusion: Assuming ECMO availability within a 30-minute transport time throughout the regional system, routing patients with rVF/VT to ECMO-capable centers could improve survival with CPC 1-2 nearly three-fold and result in 44 additional patients/year with meaningful survival.

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