Abstract 10276: Impact of Time-to-Compression on Out-of-Hospital Cardiac Arrest Survival Outcomes: A National Registry Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jia Ling Goh ◽  
Pin Pin Pek ◽  
Stephanie Fook-Chong ◽  
Andrew Ho ◽  
Benjamin S Leong ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
National Registry ◽  
Exclusion Criterion ◽  
Survival Outcomes ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
The Difference ◽  
Definition Of ◽  
Cardiac Arrest Survival

Introduction: Time To first Compression (TTC) in out-of-hospital cardiac arrests (OHCA) is thought to be an important predictor of survival outcomes. Guidelines such as the Journal of American College of Cardiology Scientific Expert Panel recommend that extracorporeal membrane oxygenation (ECMO) should not be used on OHCA patients with TTC > 10 minutes. However, there is no literature validating this exclusion criterion on OHCA survival and neurological outcomes. This study aimed to evaluate the difference in neurological outcomes and survival to discharge of patients with CPR administered after 10 minutes, compared to within 10 minutes. Methodology: Data of OHCAs from 2012-2017 in Singapore were extracted from our national OHCA registry. We compared patients who received CPR within 10 minutes versus those who received CPR after 10 minutes. Primary outcomes were favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1 and 2), and secondary were survival to hospital discharge or 30-day-survival. Results: There were 12,771 OHCAs analyzed, with 5,704 patients with TTC </=10 minutes and 7,067 with TTC >10 minutes. Fewer patients survived to hospital discharge/30 th day with TTC > 10 minutes (aOR 0.43, 95%CI: 0.32-0.58) and survival with good neurological outcomes was lower (aOR 0.51; 95%CI: 0.41-0.62). Other significant predictors of good neurological outcomes included age (aOR 0.98, 95%CI: 0.98 - 0.99), witnessed arrest (aOR 2.39, 95%CI: 1.69-3.40), bystander AED (aOR 1.55, 95%CI: 1.12-2.26), and presence of shockable rhythm (aOR 8.76, 95%CI: 7.12-10.78). A cut-off of 17.5 minutes (aOR 0.43, 95%CI:0.28-0.65) resulted in <1% (127 out of 12,771) chance of survival with good neurological function based on the medical definition of Futility (specificity 0.84 sensitivity 0.84 ROC 0.91). Conclusion: Our study showed that there is a significant difference in survival and favourable neurological outcomes when TTC was >10 minutes. However, more data-driven cut-off timings/criteria should be considered instead of the arbitrary 10 minutes for eligibility of ECMO therapy.

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.

scholarly journals Utility of opening rhythms in predicting time to return of spontaneous circulation in cardiac arrest victims in a resource constrained setting: a single centre prospective observational study

2019 ◽  
Vol 7 (12) ◽  
pp. 4709
Author(s):  
Appu Suseel ◽  
Siju V. Abraham ◽  
Radha K. R.
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Cardiopulmonary Arrest ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Resource Constrained ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Mean Time

Background: Time to ROSC has been shown to be an important and independent predictor of mortality and adverse neurological outcome. In resource limited situations judicious deployment of resources is crucial. Prognostication of arrest victims may aid in better resource allocation. This study aimed to assess the time to Return of Spontaneous Circulation (ROSC) in cardiac arrest victims and its relationship with opening rhythms.Methods: Consecutive victims of cardiopulmonary arrest who presented to a single center were included in this study if they met the inclusion and exclusion criteria. Time at which opening rhythm was analyzed and time at which ROSC was achieved was noted. This was done for all cases and mean time to ROSC was calculated for each opening rhythm. All those patients who achieved ROSC were followed up till hospital discharge or death.  Primary outcome measured was achievement of ROSC and the secondary outcome was the survival to hospital discharge.Results: A sample size of 100 was calculated to yield a significance criterion of 0.05 and a power of 0.80 based on prior studies. Out of 100 patients studied. 58% had shockable rhythms and 42% had non-shockable rhythms.  Mean time to ROSC for shockable rhythm was 5.55±3.51 minutes, and for non-shockable rhythm is 17.29±4.18 minutes.  There was a statistically significant difference between opening rhythms in terms of survival to hospital discharge (p=0.0329).Conclusions: Cardiac arrests with shockable rhythms attained ROSC faster when compared to nonshockable rhythms. Shockable rhythms have a better survival to hospital discharge when compared to shockable rhythms. Opening rhythms may aid the clinician in better utility of resources in a resource constrained setting.

Abstract 120: Outcomes of Out-of-Hospital Cardiac Arrest in Children

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Natalie Jayaram ◽  
Bryan McNally ◽  
Fengming Tang ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Temporal Trends ◽  
Pulseless Electrical Activity ◽  
Patient Characteristics ◽  
National Registry ◽  
Older Children ◽  
Shockable Rhythm ◽  
Study Population ◽  
Hospital Cardiac Arrest

Background: As pediatric out-of-hospital cardiac arrest (OHCA) occurs infrequently, little is known about survival outcomes in children. We examined whether OHCA survival in children differed by patients’ age, sex, and race, as well as recent survival trends. Methods: Within the Cardiac Arrest Registry to Enhance Survival (CARES), a prospective U.S. OHCA registry encompassing 64 million residents, we identified patients less than 18 years of age with an OHCA from October, 2005 to December, 2012. We examined whether survival differed by patients’ age (≤1 year, 1-8 years, >8 years), sex, race, and initial cardiac arrest rhythm, using modified Poisson regression, adjusted for patient characteristics. Similarly, we examined trends in survival, with years 2005-7 as the reference. Results: A total of 1,412 patients with an OHCA were identified, of which 67 (4.7%) were infants, 918 (65.0%) were younger children, and 427 (30.2%) older children. Sixty percent of the study population was male and 33.4% were black. The vast majority of arrests involved a non-shockable rhythm, with only 9.2% of patients having a first documented rhythm of ventricular tachycardia (VT) or ventricular fibrillation (VF). Overall, 103 (7.3%) patients survived to hospital discharge. Of those with non-shockable rhythms (asystole, pulseless electrical activity, and unknown, non-shockable rhythms), 4.4% survived to discharge compared with a survival of 36.2% in those with VT or VF (P<0.001). After adjustment for patient characteristics, children 1-8 years of age were less likely to survive to hospital discharge compared with children >8 years of age (rate ratio [RR]: 0.52; 95% confidence interval [CI]: 0.34, 0.82). In addition, OHCAs due to VT or VF were associated with improved survival (RR 6.67; 95% CI 4.35, 10.23). In contrast, there were no differences in survival by sex or race. Additionally, no temporal trends in survival were observed (p=0.47). Conclusion: In a large, national registry of pediatric OHCA, we found no disparities in survival by patients’ sex, race, or year of arrest, although survival was lower in young children and those with non-shockable cardiac arrest rhythms.

scholarly journals Refractory Ventricular Fibrillation Treated with Double Simultaneous Defibrillation: Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Hee Eun Kim ◽  
Kui Ja Lee ◽  
You Hwan Jo ◽  
Jae Hyuk Lee ◽  
Yu Jin Kim ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Admission Rate ◽  
Good Neurological Outcome ◽  
Exact Test ◽  
Shockable Rhythm ◽  
Poor Neurological Outcome ◽  
The Difference

Introduction. Refractory shockable rhythm has a high mortality rate and poor neurological outcome. Treatments for refractory shockable rhythm presenting after defibrillation and medical treatment are not definite. We conducted research on the application of double simultaneous defibrillation (DSiD) for refractory shockable rhythms. Methods. This is a retrospective pilot study performed using medical records from 1 January 2016 to 31 December 2017. The prephase was from January to December 2016. The post-phase was from January to December 2017. During the prephase, we conducted conventional defibrillation with one defibrillator, and during the post-phase, we conducted DSiD using two defibrillators. Primary outcome was survival to hospital discharge. Secondary outcomes included survival to hospital admission and good neurological outcome at 12 months. Statistical analysis was conducted using Fisher’s exact test. Data were regarded statistically significant when p<0.05. Result. A total of 38 patients were included. Twenty-one patients underwent conventional defibrillation, and 17 underwent DSiD. The DSiD group had a higher survival to admission rate (14/17 (82.4%) vs. 6/21 (28.6%), p=0.001) and showed a trend for higher survival to discharge (7/17 (41.2%) vs. 3/21 (14.3%), p=0.078). Good neurological outcome at 12 months of the DSiD group was higher than that of the conventional defibrillation group, but the difference was not statistically significant (5/17 (29.4%) vs 2/21 (9.5%), p=0.207). Conclusion. In patients with refractory shockable rhythms, DSiD has increased survival to hospital admission and a trend of increased survival to hospital discharge. However, DSiD did not improve neurological outcome at 12 months.

scholarly journals The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

CJEM ◽  
2018 ◽  
Vol 21 (3) ◽  
pp. 330-338 ◽  
Author(s):  
Alexis Cournoyer ◽  
Éric Notebaert ◽  
Sylvie Cossette ◽  
Luc Londei-Leduc ◽  
Luc de Montigny ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Hospital Discharge ◽  
Prognostic Significance ◽  
Probability Of Survival ◽  
Shockable Rhythm ◽  
Malignant Arrhythmia ◽  
The Relationship ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

ABSTRACTObjectivesPatients suffering from an out-of-hospital cardiac arrest (OHCA) associated with an initial shockable rhythm have a better prognosis than their counterparts. The implications of recurrent or refractory malignant arrhythmia in such context remain unclear. The objective of this study is to evaluate the association between the number of prehospital shocks delivered and survival to hospital discharge among patients in OHCA.MethodsThis cohort study included adult patients with an initial shockable rhythm over a 5-year period from a registry of OHCA in Montreal, Canada. The relationship between the number of prehospital shocks delivered and survival to discharge was described using dynamic probabilities. The association between the number of prehospital shocks delivered and survival to discharge was assessed using multivariable logistic regression.ResultsA total of 1,788 patients (78% male with a mean age of 64 years) were included in this analysis, of whom 536 (30%) received treatments from an advanced care paramedic. A third of the cohort (583 patients, 33%) survived to hospital discharge. The probability of survival was highest with the first shock (33% [95% confidence interval 30%-35%]), but decreased to 8% (95% confidence interval 4%-13%) following nine shocks. A higher number of prehospital shocks was independently associated with lower odds of survival (adjusted odds ratio=0.88 [95% confidence interval 0.85-0.92], p < 0.001).ConclusionSurvival remains possible even after a high number of shocks for patients suffering from an OHCA with an initial shockable rhythm. However, requiring more shocks is independently associated with worse survival.

scholarly journals Outcomes of Early versus Late Endotracheal Intubation in Patients with Initial Non-Shockable Rhythm Cardiopulmonary Arrest in the Emergency Department

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Kiattichai Daorattanachai ◽  
Winchana Srivilaithon ◽  
Vitchapon Phakawan ◽  
Intanon Imsuwan
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Airway Management ◽  
Hospital Discharge ◽  
Endotracheal Intubation ◽  
Neurological Outcome ◽  
Independent Effect ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Favorable Neurological Outcome

Background. Sudden cardiac arrest is a critical condition in the emergency department (ED). Currently, there is no considerable evidence supporting the best time to complete advanced airway management (AAM) with endotracheal intubation in cardiac arrest patients presented with initial non-shockable cardiac rhythm. Objectives. To compare survival to hospital discharge and discharge with favorable neurological outcome between the ED cardiac arrest patients who have received AAM with endotracheal intubation within 2 minutes (early AAM group) and those over 2 minutes (late AAM group) after the start of chest compression in ED. Methods. We conducted a retrospective cohort study involving the ED cardiac arrest patients who presented with initial non-shockable rhythm in ED. Multivariable logistic regression analysis was used to evaluate the independent effect of early AAM on outcomes. The outcomes included the survival to hospital discharge and discharge with favorable neurological outcome. Results. There were 416 eligible participants: 209 in the early AAM group and 207 participants in the late AAM group. The early AAM group showed higher survival to hospital discharge compared with the late AAM group, but no statistically significant difference (adjusted odds ratio (aOR): 1.28, 95% confidence interval (CI): 0.59 -2.76, p = 0.524 ). Discharge with favorable neurological outcome is also higher in the early AAM group (aOR: 1.68, 95% CI, 0.52 -5.45, p = 0.387 ). Conclusion. This study did not demonstrate a significant improvement of survival to hospital discharge and discharge with favorable neurological outcome in the ED cardiac arrest patients with initial non-shockable cardiac arrest who underwent early AAM within two minutes. More research is needed on the timing of AAM and on airway management strategies to improve survival.

scholarly journals Shockable Rhythm at Hospital Arrival as the Predictor of Favourable Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest (OHCA) Receiving Extracorporeal Cardiopulmonary Resuscitation (ECPR)

2021 ◽  
Author(s):  
Pei-I Su ◽  
Min-Shan Tsai ◽  
Wei-Ting Chen ◽  
Chih-Hung Wang ◽  
Wei-Tien Chang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Multiple Logistic Regression ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Arrival ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Abstract Introduction: For patients with out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation under advanced life support, extracorporeal cardiopulmonary resuscitation (ECPR) is the only lifesaving option. This study aimed to analyse the predictors of favourable neurological outcomes (FO, cerebral performance category 1-2) at hospital discharge among patients with OHCA following ECPR.Methods: In this single-centre retrospective study, 126 patients with OHCA who received ECPR between January 2012 and December 2019 were enrolled. The primary outcome was the FO at hospital discharge. The predictors of FO were assessed using multiple logistic regression analysis. Patients with an initial shockable rhythm were further analysed according to the cardiac rhythm at the time of hospital arrival. Results: Among the patients who received ECPR, the FO at hospital discharge was 21%. Certain resuscitation variables were associated with FO including witnessed collapse (P=0.014), bystander CPR (P=0.05), shorter no-flow time (P=0.008), and a shockable rhythm at hospital arrival (P=0.009). Multiple logistic regression showed that a shockable rhythm at hospital arrival was the only independent predictor of FO at discharge (odds ratio, 3.012; 95% confidence interval, 1.06-8.53; P=0.038). Among patients with an initial shockable rhythm, the group with a shockable rhythm at hospital arrival had a FO of 30%, which was significantly higher than the 11% in the non-shockable rhythm group (P=0.043).Conclusions: In patients with OHCA who received ECPR, a shockable rhythm at the time of hospital arrival was associated with favourable neurological outcomes at discharge. The ECPR selection criteria could consider the rhythm at hospital arrival.

Clinical Factors Associated with Progression to AIDS in the Italian Cohort of HIV-Positive Hemophiliacs

1994 ◽  
Vol 72 (01) ◽  
pp. 033-038 ◽  
Author(s):  
N Schinaia ◽  
A M G Ghirardini ◽  
M G Mazzucconi ◽  
G Tagariello ◽  
M Morfini ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
National Registry ◽  
Factor Ix ◽  
Clotting Factor ◽  
Coagulation Disorders ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Congenital Coagulation Disorders ◽  
Clotting Factor Concentrates

SummaryThis study updates estimates of the cumulative incidence of AIDS among Italian patients with congenital coagulation disorders (mostly hemophiliacs), and elucidates the role of age at seroconversion, type and amount of replacement therapy, and HBV co-infection in progression. Information was collected both retrospectively and prospectively on 767 HIV-1 positive patients enrolled in the on-going national registry of patients with congenital coagulation disorders. The seroconversion date was estimated as the median point of each patient’s seroconversion interval, under a Weibull distribution applied to the overall interval. The independence of factors associated to faster progression was assessed by multivariate analysis. The cumulative incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 17.0% (95% Cl = 14.1-19.9%) over an 8-year period for Italian hemophiliacs. Patients with age greater than or equal to 35 years exhibited the highest cumulative incidence of AIDS over the same time period, 32.5% (95% Cl = 22.2-42.8%). Factor IX recipients (i.e. severe B hemophiliacs) had higher cumulative incidence of AIDS (23.3% vs 14.2%, p = 0.01) than factor VIII recipients (i.e. severe A hemophiliacs), as did severe A hemophiliacs on less-than-20,000 IU/yearly of plasma-derived clotting factor concentrates, as opposed to A hemophiliacs using an average of more than 20,000 IU (18.8% vs 10.9%, p = 0.02). No statistically significant difference in progression was observed between HBsAg-positive vs HBsAg-negative hemophiliacs (10.5% vs 16.4%, p = 0.10). Virological, immunological or both reasons can account for such findings, and should be investigated from the laboratory standpoint.

Cranial crassicaudiasis in two coastal dolphin species from South Africa is predominantly a disease of immature individuals

2020 ◽  
Vol 139 ◽  
pp. 93-102 ◽  
Author(s):  
MF Van Bressem ◽  
P Duignan ◽  
JA Raga ◽  
K Van Waerebeek ◽  
N Fraijia-Fernández ◽  
...  
Keyword(s):  
South Africa ◽  
Bone Development ◽  
Bottlenose Dolphins ◽  
Fatal Outcome ◽  
Population Level ◽  
Cape Coast ◽  
Osteolytic Lesions ◽  
Immune Mediated ◽  
Significant Difference ◽  
The Difference

Crassicauda spp. (Nematoda) infest the cranial sinuses of several odontocetes, causing diagnostic trabecular osteolytic lesions. We examined skulls of 77 Indian Ocean humpback dolphins Sousa plumbea and 69 Indo-Pacific bottlenose dolphins Tursiops aduncus, caught in bather-protecting nets off KwaZulu-Natal (KZN) from 1970-2017, and skulls of 6 S. plumbea stranded along the southern Cape coast in South Africa from 1963-2002. Prevalence of cranial crassicaudiasis was evaluated according to sex and cranial maturity. Overall, prevalence in S. plumbea and T. aduncus taken off KZN was 13 and 31.9%, respectively. Parasitosis variably affected 1 or more cranial bones (frontal, pterygoid, maxillary and sphenoid). No significant difference was found by gender for either species, allowing sexes to be pooled. However, there was a significant difference in lesion prevalence by age, with immature T. aduncus 4.6 times more likely affected than adults, while for S. plumbea, the difference was 6.5-fold. As severe osteolytic lesions are unlikely to heal without trace, we propose that infection is more likely to have a fatal outcome for immature dolphins, possibly because of incomplete bone development, lower immune competence in clearing parasites or an over-exuberant inflammatory response in concert with parasitic enzymatic erosion. Cranial osteolysis was not observed in mature males (18 S. plumbea, 21 T. aduncus), suggesting potential cohort-linked immune-mediated resistance to infestation. Crassicauda spp. may play a role in the natural mortality of S. plumbea and T. aduncus, but the pathogenesis and population level impact remain unknown.

The Distinction between [P] and [S]

2017 ◽  
Author(s):  
Galen Strawson
Keyword(s):  
Personal Identity ◽  
Radical Change ◽  
Legal Responsibility ◽  
The Difference ◽  
Definition Of ◽  
Over Time

This chapter examines the difference between John Locke's definition of a person [P], considered as a kind of thing, and his definition of a subject of experience of a certain sophisticated sort [S]. It first discusses the equation [P] = [S], where [S] is assumed to be a continuing thing that is able to survive radical change of substantial realization, as well as Locke's position about consciousness in relation to [P]'s identity or existence over time as [S]. It argues that Locke is not guilty of circularity because he is not proposing consciousness as the determinant of [S]'s identity over time, but only of [S]'s moral and legal responsibility over time. Finally, it suggests that the terms “Person” and “Personal identity” pull apart, in Locke's scheme of things, but in a perfectly coherent way.

Sign in / Sign up

Export Citation Format

Share Document