Abstract 10618: A Head up CPR Based Care Bundle Improves the Likelihood of Survival to Hospital Discharge After Out of Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Johanna C Moore ◽  
José Labarere ◽  
Charles Lick ◽  
Sue Duval ◽  
Joe Holley ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Propensity Score Analysis ◽  
Survival Rates ◽  
Care Bundle ◽  
Recording Time ◽  
Suction Cup ◽  
Device Placement ◽  
Hospital Cardiac Arrest ◽  
Historical Controls

Introduction: Survival rates after out-of-hospital cardiac arrest (OHCA) remain poor with widespread use of conventional (C) CPR. Based on pre-clinical studies showing improved cerebral flow and neurologically-intact survival, a FDA approved automated Head Up Positioning (AHUP) device for CPR was developed for use with an impedance threshold device (ITD), and manual and/or automated suction cup-based CPR. A prospective observational IRB approved registry was created to track use and clinical outcomes with this AHUP device based bundle. Hypothesis: Faster time to use of an AHUP CPR bundle improves survival to hospital discharge after OHCA versus historical controls treated with C-CPR. Methods: Registry patients from sites routinely recording time from 911 call to AHUP device placement (T 911 ) were included. C-CPR controls were from 3 prior randomized prospective CPR trials: 1) Resuscitation Outcomes Consortium Prehospital Resuscitation using an IMpedance valve and Early versus Delayed (ROC PRIMED) Study, 2) Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study (ROC-ALPS), 3) The ResQTrial. Propensity score analysis was performed using logistic regression for baseline characteristics including age, sex, witnessed arrest, bystander CPR, shockable rhythm, and time to first responder CPR. Each AHUP patient was matched with up to 4 C-CPR patients. Results: Of 11 U.S. sites reporting AHUP CPR outcomes, 6 had time from 911 call to AHUP device placement recorded (n = 227). The model yielded a c-statistic of 0.76. Stratified by T 911 , the odds of survival with AHUP CPR were significantly higher than with C-CPR between T 911 < 7 minutes (OR 4.57, 95% CI 1.3-16.0) and T 911 < 15 minutes (OR 2.01, 95% CI 1.1-3.8). There was a time dependent effect of AHUP device placement on survival (See Figure). Conclusions: More rapid initiation of an AHUP CPR bundle resulted in improved survival to hospital discharge versus historical controls treated with C-CPR in OHCA.

Abstract 64: A Tale of Seven EMS Systems: An Impedance Threshold Device and Improved CPR Techniques Double Survival Rates After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tom P Aufderheide ◽  
Marvin Birnbaum ◽  
Charles Lick ◽  
Brent Myers ◽  
Laurie Romig ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Life Support ◽  
Survival Rates ◽  
Heart Association ◽  
Outcome Data ◽  
Therapeutic Interventions ◽  
Threshold Device ◽  
Hospital Cardiac Arrest ◽  
Impedance Threshold Device

Introduction: Maximizing outcomes after cardiac arrest depends on optimizing a sequence of interventions from collapse to hospital discharge. The 2005 American Heart Association (AHA) Guidelines recommended many new interventions during CPR (‘New CPR’) including use of an Impedance Threshold Device (ITD). Hypothesis: The combination of the ITD and ‘New CPR’ will increase return of spontaneous circulation (ROSC) and hospital discharge (HD) rates in patients with an out-of-hospital cardiac arrest. Methods: Quality assurance data were pooled from 7 emergency medical services (EMS) systems (Anoka Co., MN; Harris Co., TX; Madison, WI; Milwaukee, WI; Omaha, NE; Pinellas Co., FL; and Wake Co., NC) where the ITD (ResQPOD®, Advanced Circulatory Systems; Minneapolis, MN) was deployed for >3 months. Historical or concurrent control data were used for comparison. The EMS systems simultaneously implemented ‘New CPR’ including compression/ventilation strategies to provide more compressions/min and continuous compressions during Advanced Life Support. All sites stressed the importance of full chest wall recoil. The sites have a combined population of ~ 3.2 M. ROSC data were available from all sites; HD data were available as of June 2007 from 5 sites (MN, TX, Milwaukee, NE, NC). Results: A total of 893 patients treated with ‘New CPR’ + ITD were compared with 1424 control patients. The average age of both study populations was 64 years; 65% were male. Comparison of the ITD vs controls (all patients) for ROSC and HD [Odds ratios (OR), (95% confidence intervals), and Fisher’s Exact Test] were: 37.9% vs 33.8% [1.2, (1.02, 1.40), p=0.022] and 15.7% vs 7.9% [2.2, (1.53, 3.07), p<0.001], respectively. Patients with ventricular fibrillation had the best outcomes in both groups. Neurological outcome data are pending. Therapeutic hypothermia was used in some patients (MN, NC) after ROSC. Conclusion: Adoption of the ITD + ‘New CPR’ resulted in only a >10% increase in ROSC rates but a doubling of hospital discharge rates, from 7.9% to 15.7%, (p<0.001). These data represent a currently optimized sequence of therapeutic interventions during the performance of CPR for patients in cardiac arrest and support the widespread use of the 2005 AHA CPR Guidelines including use of the ITD.

Abstract 111: Age-Dependent Trends in Survival After Adult In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sebastian Wiberg ◽  
Mathias J Holmberg ◽  
Michael Donnino ◽  
Jesper Kjaergaard ◽  
Christian Hassager ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Age Groups ◽  
Spontaneous Circulation ◽  
Good Neurological Outcome ◽  
Absolute Increase ◽  
Hospital Cardiac Arrest ◽  
Over Time

Background: While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims or extends to older patients as well. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. Methods: This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between January 2000 and December 2016. The primary outcome was survival to hospital discharge, while secondary outcomes included rates of return of spontaneous circulation (ROSC) and neurological outcome at discharge. Patients were stratified into five age groups: < 50 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. Analyses of interaction were included to assess differences in survival trends between age groups. Results: A total of 234,767 IHCA patients were included for the analyses. The absolute increase in survival per calendar year was 0.8% (95%CI 0.7 - 1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95%CI 0.4 - 0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95%CI 0.4 - 0.6%, p < 0.001) for patients older than 80 years. Further, a significant increase in both rates of ROSC and survival with a good neurological outcome was seen for all age groups. In both unadjusted and adjusted analyses of survival, we observed a significant interaction between calendar year and age group ( p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. Conclusions: For patients with IHCA, survival to discharge, ROSC, and survival to discharge with a good neurological outcome have improved significantly from 2000 to 2016 for all age groups.

scholarly journals MP56: Intraosseous versus intravenous access in pediatric out-of-hospital cardiac arrest: an examination of prehospital vascular access methods and survival rates

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S63-S63
Author(s):  
F. Besserer ◽  
J. Dirk ◽  
G. Meckler ◽  
J. Tijssen ◽  
A. DeCaen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Regression Model ◽  
Hospital Discharge ◽  
Vascular Access ◽  
Vascular System ◽  
Survival Rates ◽  
Access Methods ◽  
Pediatric Resuscitation ◽  
The Usa ◽  
Hospital Cardiac Arrest

Introduction: Intraosseous (IO) and intravenous (IV) access to the vascular system for the delivery of fluid and medication is a component of advanced pediatric resuscitation. Data describing the use of IV or IO vascular access methods and outcomes of pediatric out-of-hospital cardiac arrest (OHCA) are limited. Methods: We analyzed prospectively collected data of non-traumatic OHCA of the Resuscitation Outcomes Consortium registry in Canada and the USA (2011-2015). We included patients 17 years of age and younger who were treated by emergency medical services (EMS). We described the vascular access routes utilized, and the success rate of these attempts. We performed a logistic regression model, to evaluate the association of vascular access route and survival, adjusting for age, sex, shockable initial rhythm, witnessed status, public location, EMS arrival interval and time from 911 call to vascular access. In this model, we excluded patients with failed, multiple site or no vascular access attempts during the resuscitation. Results: Of 1549 non-traumatic pediatric OHCA, 822/895 (92%) and 345/488 (71%) had successful IO and IV vascular access attempts, respectively. IO access was more common in younger cases. Of 761 cases included in the regression model, 30/601 (5%) of IO-treated cases survived to hospital discharge, in comparison to 40/160 (25%) of IV-treated cases. Intraosseous access was associated with a decreased survival to hospital discharge (adjusted OR 0.46; 95% CI 0.21 to 0.98). Conclusion: In pediatric patients with OHCA, intraosseous vascular access was more commonly successful than IV placement and more common among younger cases. However, in cases with successful vascular access, IO use was associated with lower survival to hospital discharge.

Abstract 12494: The Disparities of Gender-Based Out of Hospital Cardiac Arrest Characteristics and Outcomes: Comparing Rural to Urban Vancouver Island

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Rahaf Al Assil
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Rural Areas ◽  
Survival Rates ◽  
Vancouver Island ◽  
P Value ◽  
Urban Settings ◽  
Rural Settings ◽  
Gender Based ◽  
Hospital Cardiac Arrest

Introduction: The relationship between the “chain of survival” metrics of Out of Hospital Cardiac Arrest (OHCA) and survival rates in rural settings has not been fully examined. In previous studies, low survival rate was attributable to the modifiable prehospital metrics and Return Of Spontaneous Circulation (ROSC). We sought to examine the association of the modifiable and non-modifiable OHCA characteristics and patient outcomes with rural settings. Methods: We did a post-hoc analyses of data from the British Columbia cardiac arrest registry, which enrolled all emergency medical system (EMS)-treated OHCAs. All non-EMS-witnessed OHCAs on Vancouver Island from Jan. 2019 to Oct. 2020 were included. The independent variable of interest was rural versus urban settings. Rural areas were defined as all areas outside the urban clusters (population ≥ 1000 and a population density of ≥ 400/km2). Our outcomes were 1. Post resuscitation ROSC, and 2. Survival to hospital discharge. We reported gender-mediated measures and adjusted odds ratios using logistic regression models. Results: We included 1172 OHCA patients, with 23% in rural settings, 33% Female, 30% had ROSC, and 23% survived to hospital discharge. The median EMS response time, from 911-call to first EMS arrival, was prolonged [10.5 mins (IQR 7.5-15)] in rural settings compared to urban settings [6.5 mins (IQR 5-9)] (p value<.001) . Among females, rural settings were associated with higher odds of bystander CPR compared to males [(OR 1.86; 95% CI 1.04-3.35), (OR 1.42; 95% CI 0.95-2.13)], respectively. After adjusting for all covariates, rural settings were associated with lower odds of ROSC among males compared to females [(OR 0.53; 95% CI 0.31-0.90), (OR 0.70; 95% CI 0.34-1.41)], respectively; however, not associated with survival to hospital discharge. Conclusions: There are significant disparities in the modifiable prehospital OHCA characteristics, and post resuscitation ROSC between rural and urban Vancouver Island. An officially integrated rural CPR community-based program, and innovations focused on gender-based implementation may significantly improve OHCA survival rates and subsequent prognostication.

scholarly journals P115: Outcomes of out of hospital cardiac arrest in First Nations vs. non-First Nations patients in Saskatoon

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S105-S106
Author(s):  
O. Scheirer ◽  
A. Leach ◽  
S. Netherton ◽  
P. Mondal ◽  
T. Hillier ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Arrest ◽  
First Nations ◽  
Hospital Discharge ◽  
Response Times ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
First Nations People ◽  
Hospital Cardiac Arrest

Introduction: One in nine (11.7%) people in Saskatchewan identifies as First Nations. In Canada, First Nations people experience a higher burden of cardiovascular disease when compared to the general population, but it is unknown whether they have different outcomes in out of hospital cardiac arrest (OHCA). Methods: We reviewed pre-hospital and inpatient records of patients sustaining an OHCA between January 1st, 2015 and December 31st, 2017. The population consisted of patients aged 18 years or older with OHCA of presumed cardiac origin occurring in the catchment area of Saskatoon's EMS service. Variables of interest included, age, gender, First Nations status (as identified by treaty number), EMS response times, bystander CPR, and shockable rhythm. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. Results: In all, 372 patients sustained OHCA, of which 27 were identified as First Nations. First Nations patients with OHCA tended to be significantly younger (mean age 46 years vs. 65 years, p &lt; 0.0001) and had shorter EMS response times (median times 5.3 minutes vs. 6.2 minutes, p = 0.01). There were no differences between First Nations and non-First Nations patients in terms of incidence of shockable rhythms (24% vs. 26%, p = 0.80), ROSC (42% vs. 41%, p = 0.87), survival to admission (27% vs 33%, p = 0.53), and survival to hospital discharge (15% vs. 12%, p = 0.54). Conclusion: In Saskatoon, First Nations patients sustaining OHCA appear to have similar survival rates when compared with non-First Nations patients, suggesting similar baseline care. Interestingly, First Nations patients sustaining OHCA were significantly younger than their non-First Nations counterparts. This may reflect a higher burden of cardiovascular disease, suggesting a need improved prevention strategies.

Improving post-resuscitation care after out-of-hospital cardiac arrest

2020 ◽  
Vol 12 (1) ◽  
pp. 14-21
Author(s):  
Ruth Moira Fisher
Keyword(s):  
Cardiac Arrest ◽  
Care Pathway ◽  
Average Rate ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Care Bundle ◽  
Care Pathways ◽  
Specialist Care ◽  
Delivery Of Care ◽  
Hospital Cardiac Arrest

Introduction: The average rate of survival following an out-of-hospital cardiac arrest (OHCA) in the UK was 7–8% at the start of 2019. An estimated 60 000 OHCAs are attended by UK ambulance services annually and, despite developments in prehospital and post-resuscitation care, there are significant variations in survival between regions and countries. Aims: This study aims to identify the potential for care pathways, evaluate UK practices and review the evidence for direct referral of OHCA patients to dedicated cardiac arrest centres. Methods: Evidence was gathered from 20 articles identified through a systematic search of articles related to OHCA and post-resuscitation care, as well as from NHS England in relation to performance and outcomes. Results: Between April 2018 and January 2019, 30.6% of patients experiencing an OHCA had a recorded ROSC (return of spontaneous circulation), and 10.2% survived. However, the 58.7% compliance with the post-ROSC care bundle by ambulance services suggests variations in the delivery of post-resuscitation care. At present, UK ambulance services stabilise and transfer OHCA patients with ROSC to the nearest emergency department, which may not provide specialist services. Holland and Norway report survival rates of 21% and 25% respectively, and operate a centralised approach to post-resuscitation care through designated cardiac arrest centres, which provide specialist care that helps to improve the likelihood of survival. While no randomised controlled trials have been carried out in relation to cardiac arrest centres, it is recognised that the quality of care in the post-resuscitation phase is important, as this is when the highest proportion of deaths occur. Conclusion: Further research into specific care pathways and centralised care should be carried out, and an OHCA post-resuscitation care pathway should be developed to improve the delivery of care and survival.

Abstract 126: Intravenous Versus Intraosseous Epinephrine Administration for Pediatric Patients with Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Masashi Okubo ◽  
Cameron Dezfulian ◽  
Francis X Guyette ◽  
Christian Martin-Gill ◽  
Sylvia Owusu-Ansah ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Propensity Score ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Pediatric Patients ◽  
Propensity Score Analysis ◽  
Epinephrine Administration ◽  
Significant Difference ◽  
Hospital Cardiac Arrest

Introduction: The 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation recommend intravenous (IV) or intraosseous (IO) epinephrine administration for pediatric patients with out-of-hospital cardiac arrest (OHCA). However, it is unknown whether the route of epinephrine administration affects patient outcomes. Our objective was to evaluate the association between the route of epinephrine administration and survival. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epistry, a prospective multicenter OHCA registry from 2011 through 2015 in North America. We included pediatric patients (≤18 years) with OHCA for whom emergency medical services (EMS) providers attempted resuscitation and administered epinephrine via IV or IO. We excluded patients who received endotracheal epinephrine, received both IV and IO epinephrine, received IV epinephrine with failed IO access, and received IO epinephrine with failed IV access. The primary outcome was survival to hospital discharge. We used multivariable logistic regression and adjusted for age, sex, initial rhythm, location of arrest, witness status, receiving layperson cardiopulmonary resuscitation, 9-1-1 call to EMS arrival, and advanced airway management. We also conducted a propensity score matching analysis with the same covariates. Results: Of the eligible 831 pediatric patients with OHCA, 226 (27.2%) received IV epinephrine and 605 (72.8%) IO epinephrine. Median interval between 9-1-1 call and epinephrine administration was 16.4 minutes (interquartile range [IQR] 12.9-21.0) in IV group and 16.2 minutes (IQR 12.8-20.0) in IO group. In the logistic regression model, the adjusted odds ratio (OR) of the IO group for survival to hospital discharge was 0.99 (95% confidence interval [CI] 0.41-2.40), compared with the IV group. Similarly, in the propensity score analysis, 218 patients underwent matching with good balance (standardized differences <0.25 for all covariates) and the OR of the IO group for survival to hospital discharge was 1.00 (95% CI 0.38-2.62). Conclusions: We observed no significant difference in survival to hospital between pediatric patients with OHCA who received epinephrine via IV and IO routes.

scholarly journals Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Son Ngoc Do ◽  
Chinh Quoc Luong ◽  
Dung Thi Pham ◽  
My Ha Nguyen ◽  
Tra Thanh Ton ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Survival Rates ◽  
Trauma System ◽  
First Aid ◽  
System Of Care ◽  
Healthcare Personnel ◽  
Significant Difference ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. Methods We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. Results Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). Conclusion In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.

Abstract 426: Factors Contributing to Out-Of-Hospital Cardiac Arrest Mortality Trends in the City of Detroit (2014-2018)

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Shobi Mathew ◽  
James H Paxton ◽  
Brian Reed ◽  
Joseph B Miller ◽  
Howard Klausner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Survival Rates ◽  
Temperature Management ◽  
Steady Increase ◽  
Heart Catheterization ◽  
Mortality Trends ◽  
Patient Demographics ◽  
Left Heart Catheterization ◽  
Hospital Cardiac Arrest

Introduction: Survival with good neurologic outcome following out-of-hospital cardiac arrest (OHCA) requires intensive post-ROSC care. In response to a recent decline in OHCA survival rates in Detroit, we conducted an analysis to identify factors contributing to this regression. Methods: CARES data from Detroit EMS transports were analyzed, including adult non-traumatic OHCA patients treated from 2014-2018 at four hospitals. Patient demographics, conditions of the arrest, and post-ROSC interventions including left heart catheterization, (LHC) and targeted temperature management, (TTM), were correlated to survival to hospital discharge and discharge with CPC 1 or 2. We calculated crude and adjusted survival rates across sites. Survival rates were adjusted for Utstein criteria using multilevel multi-variable regression analyses. Results: A total of 5,175 CARES patients were included. There was no difference in Utstein criteria between years, other than a small increase in the rate of witnessed arrest. We noted a steady decrease in LHC, and steady increase in TTM rate over the 5 years. There was a system-wide decrease in survival to hospital discharge during 2018, though the percentage of patients discharged with CPC 1 or 2 was similar. We found a strong, though insignificant, trend for LHC rate and survival: 0.72 (p = 0.1057), R 2 : 0.88, Adjusted R 2 : 0.76; and for survival with CPC 1 or 2: 0.59 (p = 0.5172), R 2 : 0.72, Adjusted R 2 : 0.44. In 2018, the rate of patients with LHC and good CPC nearly doubled. Conclusion: During the study period, we found a steady increase in TTM rate and concomitant decrease in LHC rate. The rate of LHC correlated best with survival to hospital discharge. In 2018, an increase in the proportion of patients with CPC 1 or 2 receiving LHC occurred, despite a decline in the overall rate of LHC.

scholarly journals Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Yu-Lin Hsieh ◽  
Meng-Che Wu ◽  
Jon Wolfshohl ◽  
James d’Etienne ◽  
Chien-Hua Huang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Vascular Access ◽  
Subgroup Analysis ◽  
Observational Studies ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hospital Cardiac Arrest

Abstract Introduction This study is aimed to investigate the association of intraosseous (IO) versus intravenous (IV) route during cardiopulmonary resuscitation (CPR) with outcomes after out-of-hospital cardiac arrest (OHCA). Methods We systematically searched PubMed, Embase, Cochrane Library and Web of Science from the database inception through April 2020. Our search strings included designed keywords for two concepts, i.e. vascular access and cardiac arrest. There were no limitations implemented in the search strategy. We selected studies comparing IO versus IV access in neurological or survival outcomes after OHCA. Favourable neurological outcome at hospital discharge was pre-specified as the primary outcome. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I2 statistics. Time to intervention, defined as time interval from call for emergency medical services to establishing vascular access or administering medications, was hypothesized to be a potential outcome moderator and examined in subgroup analysis with meta-regression. Results Nine retrospective observational studies involving 111,746 adult OHCA patients were included. Most studies were rated as high quality according to Newcastle-Ottawa Scale. The pooled results demonstrated no significant association between types of vascular access and the primary outcome (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27–1.33; I2, 95%). In subgroup analysis, time to intervention was noted to be positively associated with the pooled OR of achieving the primary outcome (OR: 3.95, 95% CI, 1.42–11.02, p: 0.02). That is, when the studies not accounting for the variable of “time to intervention” in the statistical analysis were pooled together, the meta-analytic results between IO access and favourable outcomes would be biased toward inverse association. No obvious publication bias was detected by the funnel plot. Conclusions The meta-analysis revealed no significant association between types of vascular access and neurological outcomes at hospital discharge among OHCA patients. Time to intervention was identified to be an important outcome moderator in this meta-analysis of observation studies. These results call for the need for future clinical trials to investigate the unbiased effect of IO use on OHCA CPR.

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