Abstract 10617: Antiarrhythmic Use and the Posterior Probability of Neurologically Intact Survival in a Reanalysis of the Amiodarone, Lidocaine or Placebo Study in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Frederick J Brown ◽  
Steven E Rigdon ◽  
David L Brown
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Posterior Probability ◽  
Credible Interval ◽  
Antiarrhythmic Therapy ◽  
Absolute Difference ◽  
Prior Probabilities ◽  
The Absolute ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Introduction: There are no randomized controlled trials (RCT) demonstrating improvement in neurologically intact survival from antiarrhythmic therapy given during out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation/tachycardia (VF/VT). The Amiodarone, Lidocaine or Placebo Study in Out-of-Hospital Cardiac Arrest (ALPS) was an RCT of amiodarone, lidocaine or placebo whose primary end-point was survival to hospital discharge. We sought to estimate the posterior probability of the absolute risk difference of neurologically intact survival (modified Rankin Score ≤ 3) from antiarrhythmic use (amiodarone or lidocaine) compared to placebo and from the use amiodarone versus lidocaine. Methods: We performed a Bayesian reanalysis on the per-protocol population of the ALPS trial in order to calculate the posterior probability of neurologically intact survival. We derived prior probabilities from the Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation (ARREST) and Amiodarone Compared with Lidocaine for Shock-Resistant Ventricular Fibrillation (ALIVE) trials. We considered a clinically meaningful absolute difference to be ≥ 1%. Results: The posterior median probability of the absolute difference in neurologically intact survival between antiarrhythmic therapy and placebo was 2.2% (95% credible interval of -0.15% to 4.7%). There is a 96% chance that antiarrhythmic improves neurologic outcome and 86% chance of a clinically meaningful improvement. The posterior median probability of the absolute difference in neurologically intact survival between amiodarone and lidocaine was 1.5% (95% credible interval -1.6% to 4.5%). Conclusion: The results of this Bayesian analysis of the ALPS trial using likely optimistic prior probabilities derived from the ARREST trial may help inform clinicians of the value of antiarrhythmic therapy in OHCA.

scholarly journals Make it two: A case report of dual sequential external defibrillation

CJEM ◽  
2017 ◽  
Vol 20 (5) ◽  
pp. 792-797 ◽  
Author(s):  
Colin R. Bell ◽  
Adam Szulewski ◽  
Steven C. Brooks
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Case Report ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Mechanisms Of Action ◽  
Prehospital Setting ◽  
Simultaneous Discharge ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

ABSTRACTDual sequential external defibrillation (DSED) is the process of near simultaneous discharge of two defibrillators with differing pad placement to terminate refractory arrhythmias. Previously used in the electrophysiology suite, this technique has recently been used in the emergency department and prehospital setting for out-of-hospital cardiac arrest (OHCA). We present a case of successful DSED in the emergency department with neurologically intact survival to hospital discharge after refractory ventricular fibrillation (RVF) and review the putative mechanisms of action of this technique.

scholarly journals Effect of empiric antiarrhythmic therapy in resuscitated out-of-hospital cardiac arrest victims with coronary artery disease

1990 ◽  
Vol 65 (18) ◽  
pp. 1192-1197 ◽  
Author(s):  
Ali R. Moosvi ◽  
Sidney Goldstein ◽  
Sharon VanderBrug Medendorp ◽  
J.Richard Landis ◽  
Robert A. Wolfe ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Antiarrhythmic Therapy ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

Outcomes and In-hospital Treatment of Out-of-Hospital Cardiac Arrest Patients Resuscitated From Ventricular Fibrillation by Early Defibrillation

2004 ◽  
Vol 79 (5) ◽  
pp. 613-619 ◽  
Author(s):  
T. Jared Bunch ◽  
Roger D. White ◽  
Bernard J. Gersh ◽  
Win-Kuang Shen ◽  
Stephen C. Hammill ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Treatment ◽  
Early Defibrillation ◽  
Hospital Cardiac Arrest

Abstract 16924: Initial AMSA and Increased AMSA After CPR Predict Second Shock Success in Initially Shock-resistant VF During Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ulrich Herken ◽  
Weilun Quan
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Success Rate ◽  
Fourier Transformation ◽  
Amplitude Spectrum ◽  
Fast Fourier Transformation ◽  
Shock Delivery ◽  
Spectrum Area ◽  
Hospital Cardiac Arrest

Purpose: Amplitude spectrum area (AMSA), which is calculated from the ventricular fibrillation (VF) waveform using fast Fourier transformation, has been recognized as a predictor of successful defibrillation (DF) and as an index of myocardial perfusion and viability during resuscitation. In this study, we investigated whether a change in AMSA occurring during CPR would predict DF outcome for subsequent DF attempts after a failed DF. We hypothesized that a patient responding to CPR with an increase in AMSA would have an increased likelihood of DF success. Methods: This was a retrospective analysis of out-of-hospital cardiac arrest patients who received a second DF due to initially shock-resistant VF. A total of 193 patients with an unsuccessful first DF were identified in a manufacturer database of electrocardiographic defibrillator records. AMSA was calculated for the first DF (AMSA1) and the second DF (AMSA2) during a 2.1 sec window ending 0.5 sec prior to DF. A successful DF attempt was defined as the presence of an organized rhythm with a rate ≥ 40 / min starting within 60 sec from the DF and lasting for > 30 sec. After the failed first DF, all patients received CPR for 2 to 3 minutes before delivery of the second DF. Change in AMSA (dAMSA) was calculated as dAMSA = AMSA2 - AMSA1. Results: The overall second DF success rate was 14.5%. Multivariable logistic regression showed that both AMSA1 and dAMSA were independent predictors of second DF success with odds ratios of 1.24 (95% CI 1.12 - 1.38, p<0.001) and 1.27 (95% CI 1.16 - 1.41, p<0.001) for each mVHz change in AMSA or dAMSA, respectively. Conclusions: In initially DF-resistant VF, a high initial AMSA value predicted an increased likelihood of second shock success. An increase of AMSA in response to CPR also predicted a higher second shock success rate. Monitoring of AMSA during resuscitation therefore may be useful to guide CPR efforts, possibly including timing of second shock delivery. These findings also further support the value of AMSA as indicator of myocardial viability.

Abstract 12769: Amplitude-Spectral Area of the Ventricular Fibrillation Waveform and Chest Compression Quality in Witnessed and Unwitnessed Out-Of-Hospital Cardiac Arrest: Can We Predict Who is Unlikely to Survive?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Julia Indik ◽  
Zacherie Conover ◽  
Meghan McGovern ◽  
Annemarie Silver ◽  
Daniel Spaite ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Chest Compression ◽  
Stepwise Logistic Regression ◽  
Individual Subject ◽  
Spectral Area ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Background: Previous investigations in human out of hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) have shown that the frequency-based waveform characteristic, amplitude spectral area (AMSA) predicts defibrillation success and is associated with survival to hospital discharge. We evaluated the relative strength of factors associated with hospital discharge including witnessed/unwitnessed status, chest compression (CC) quality and AMSA. We then investigated if there is a threshold value for AMSA that can identify patients who are unlikely to survive. Methods: Adult OHCA patients (age ≥18), with initial rhythm of VF from an Utstein-Style database (collected from 2 EMS systems) were analyzed. AMSA was measured from the waveform immediately prior to each shock, and averaged for each individual subject (AMSA-ave). Univariate and stepwise multivariable logistic regression, and receiver-operator-characteristic (ROC) analyses were performed. Factors analyzed: age, sex, witnessed status, time from dispatch to monitor/defibrillator application, number of shocks, mean CC rate, depth, and release velocity (RV). Results: 140 subjects were analyzed, [104 M (74%), age 62 ± 14 yrs, witnessed 65%]. Survival was 38% in witnessed and 16% in unwitnessed arrest. In univariate analyses, age (P=0.001), witnessed status (P=0.009), AMSA-ave (P<0.001), mean CC depth (P=0.025), and RV (P< 0.001) were associated with survival. Stepwise logistic regression identified AMSA-ave (P<0.001), RV (P=0.001) and age (P=0.018) as independently associated with survival. The area under the curve (ROC analysis) was 0.849. The probability of survival was < 5% in witnessed arrest for AMSA-ave < 5 mV-Hz, and in unwitnessed arrest for AMSA-ave < 15 mV-Hz. Conclusion: In OHCA with an initial rhythm of VF, AMSA-ave and CC RV are highly associated with survival. Further study is needed to evaluate whether AMSA-ave may be useful to identify patients highly unlikely to survive.

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.

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