Abstract 11034: Extracorporeal Life-Support for Out-of-Hospital Cardiac Arrest: A Nationwide Multicenter Study

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
DAUN JEONG ◽  
Hansol Chang ◽  
SUNGYEON HWANG ◽  
Wonchul Cha ◽  
Tae Gun Shin ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcome ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Cerebral Performance Category ◽  
Risk Groups ◽  
Neurological Status ◽  
Real World Data ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome

Introduction: Despite promising survival and favorable neurological results in IHCA, the outcomes of ECLS for OHCA are more heterogeneous. The clinical setting for the survival and favorable neurological outcomes of ECLS in OHCA may differ from that in IHCA. Hypothesis: This study aimed to determine whether ECLS is associated with improved survival to hospital discharge with favorable neurological outcome compared to conventional cardiopulmonary resuscitation and identify in which OHCA patients the implementation of ECLS would be beneficial. Methods: The clinical outcome of OHCA treated by ECLS or CCPR between 2015 and 2020 was retrospectively investigated using KoCARC, a nationwide multicenter OHCA registry of Korea. Differences in baseline clinical characteristics were adjusted by matching propensity for ECLS. Primary outcome was 30-day survival with neurologically favorable status of cerebral performance category of 1 or 2. Restricted mean survival time (RMST) was used to compare outcome between groups. Result: Of 12,006 patients (mean age=71, male gender=65%) included, ECLS was performed in 272 patients (2.2%). In unadjusted analysis, the frequency of survival with favorable neurological status was higher in ECLS compared to CCPR (15% versus 7%, RMST 9.4 versus 3.8 days, p<0.001). Subgroup analysis revealed that the benefit of ECLS was evident in high-risk groups including initial non-shockable rhythm or CPR duration≥20 min (p<0.05, all). In analysis of propensity score-matched 271 pairs, there was no difference in the clinical outcome between ECLS and CCPR (15% versus 16%, RMST 9.4 versus 9.0 days, p=0.33), but ECLS was still better than CCPR in initial non-shockable rhythm or CPR duration≥20 min (p<0.05, all). Conclusions: In this real-world data analysis, ECLS compared to CCPR did not result in better clinical outcome of OHCA in overall. However, ECLS might be beneficial for high-risk patients such as initial non-shockable rhythm or CPR duration≥20 min.

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.

scholarly journals 1077. Reduce Anti-Microbial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S382-S382
Author(s):  
Aditya Shah ◽  
Prabij Dhungana ◽  
Kirtivardhan Vashistha ◽  
Priya Sampathkumar ◽  
John Bohman ◽  
...  
Keyword(s):  
Infectious Disease ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Task Force ◽  
Antimicrobial Prophylaxis ◽  
Extracorporeal Life Support ◽  
Antimicrobial Use ◽  
Membrane Oxygenation ◽  
Critically Ill Adults

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. Patients on ECMO are at high risk for infections, with 20.5% of adults acquiring infections while on ECMO. An Extracorporeal Life Support Organization (ELSO) Infectious Disease Task Force statement concluded that no antibiotic prophylaxis is needed for patients on ECMO though it also noted that this was based on limited data. We implemented an antimicrobial prophylaxis protocol for patients on ECMO at our institution and analyzed antimicrobial use and outcomes in these patients with a pre- and post-analysis. Methods We conducted a retrospective review of 294 patients on ECMO between July 1, 2011 and July 1, 2017. An ECMO antimicrobial prophylaxis guideline was initially implemented on July 1, 2014; there was poor adherence to the guideline and antimicrobial use actually increased. A more restrictive protocol was implemented in November 2018 with input from stakeholders including cardiac surgeons, critical care and infectious disease (ID) providers. We had a cohort of 161 patients before (July 2014–November 2018) and 37 patients after (November 2018–April 2018) the implementation of the updated protocol. We evaluated primary outcomes of gross days of antimicrobial use, percent of antibiotic-free days and days of individual antimicrobial use, adjusted for APACHE scores and ECMO duration. Results When adjusted for days on ECMO, mean antibiotic days decreased after implementation of the protocol; for vancomycin (0.27 vs. 0.02, P < 0.0003), cefepime (0.15 vs. 0.02, P < 0.02), meropenem (0.09 vs. 0, P < 0.02), zosyn (0.16 vs. 0, P < 0.002), caspofungin (0.346, 0.138 P < 0.003). This was accompanied by a nonsignificant increase in mean fluconazole use (0.29 vs. 0.37, P < 0.3). There was no impact on patient mortality or nosocomial infection rate. Additional results can be found in table. Conclusion The use of an antimicrobial prophylaxis protocol in ECMO patients led to improvement in antimicrobial usage without increasing nosocomial infections in a population at a high risk of infection. Disclosures All authors: No reported disclosures.

Elective High-Risk Percutaneous Coronary Interventions Supported by Extracorporeal Life Support

2007 ◽  
Vol 99 (6) ◽  
pp. 771-773 ◽  
Author(s):  
Jindra Vainer ◽  
Vincent van Ommen ◽  
Jos Maessen ◽  
Gijs Geskes ◽  
Leon Lamerichs ◽  
...  
Keyword(s):  
High Risk ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Percutaneous Coronary Interventions ◽  
Coronary Interventions ◽  
Percutaneous Coronary

scholarly journals Change of Hemoglobin Levels in the Early Post-cardiac Arrest Phase Is Associated With Outcome

2021 ◽  
Vol 8 ◽  
Author(s):  
Christoph Schriefl ◽  
Christian Schoergenhofer ◽  
Florian Ettl ◽  
Michael Poppe ◽  
Christian Clodi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Vascular Permeability ◽  
Fluid Balance ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Multivariable Analysis ◽  
Cerebral Performance Category ◽  
Endothelial Activation ◽  
Temperature Management ◽  
Neurologic Function

Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permeability and may be associated with neurologic function after CA.Methods: We included patients ≥18 years, who suffered a non-traumatic CA between 2013 and 2018 from the prospective Vienna Clinical Cardiac Arrest Registry. Patients without return of spontaneous circulation (ROSC), with extracorporeal life support, with any form of bleeding, undergoing surgery, receiving transfusions, without targeted temperature management or with incomplete datasets for multivariable analysis were excluded. The primary outcome was neurologic function at day 30 assessed by the Cerebral Performance Category scale. Differences of hemoglobin concentrations at admission and 12 h after ROSC were calculated and associations with neurologic function were investigated by uni- and multivariable logistic regression.Results: Two hundred and seventy-five patients were eligible for analysis of which 143 (52%) had poor neurologic function. For every g/dl increase in hemoglobin from admission to 12 h the odds of poor neurologic function increased by 26% (crude OR 1.26, 1.07–1.49, p = 0.006). The effect remained unchanged after adjustment for fluid balance and traditional prognostication markers (adjusted OR 1.27, 1.05–1.54, p = 0.014).Conclusion: Increasing hemoglobin levels in spite of a positive fluid balance may serve as a surrogate parameter of vascular permeability and are associated with poor neurologic function in the early post-cardiac arrest period.

Impact of Specific Emergency Measures on Survival in Out-of-Hospital Traumatic Cardiac Arrest

2021 ◽  
pp. 1-6
Author(s):  
Dominique Savary ◽  
François Morin ◽  
Delphine Douillet ◽  
Adrien Drouet ◽  
François Xavier Ageron ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Tension Pneumothorax ◽  
Advanced Life Support ◽  
Neurological Status ◽  
Performance Category ◽  
Traumatic Cardiac Arrest ◽  
Pelvic Stabilization ◽  
The Impact

Abstract Introduction: The management of out-of-hospital traumatic cardiac arrest (TCA) for professional rescuers entails Advanced Life Support (ALS) with specific actions to treat the potential reversible causes of the arrest: hypovolemia, hypoxemia, tension pneumothorax (TPx), and tamponade. The aim of this study was to assess the impact of specific rescue measures on short-term outcomes in the context of resuscitating patients with a TCA. Methods: This retrospective study concerns all TCA patients treated in two emergency medical units, which are part of the Northern French Alps Emergency Network (RENAU), from January 2004 through December 2017. Utstein variables and specific rescue measures in TCA were compiled: fluid expansion, pelvic stabilization, tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary endpoint was survival rate at Day 30 with good neurological status (Cerebral Performance Category [CPC] score CPC 1 and CPC 2). Results: In total, 287 resuscitation attempts in TCA were included and 279 specific interventions were identified: 262 fluid expansions, 41 pelvic stabilizations, five tourniquets, and 175 bilateral thoracostomies (including 44 with TPx). Conclusion: Among the standard resuscitation measures to treat the reversible causes of cardiac arrest, this study found that bilateral thoracostomy and tourniquet application on a limb hemorrhage improve survival in TCA. A larger sample for pelvic stabilization is needed.

Abstract 13761: Does Targeted Temperature Management Modify the Association Between Increasing Epinephrine Dose and Survival Outcomes Following Out-of-Hospital Cardiac Arrest?

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Betty Yang ◽  
Natalie Bulger ◽  
Richard Chocron ◽  
Catherine Counts ◽  
Christopher Drucker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cerebral Performance Category ◽  
Neurological Status ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Shockable Rhythm ◽  
Epinephrine Dose ◽  
The Relationship ◽  
Dose Dependent ◽  
Hospital Cardiac Arrest

Introduction: Epinephrine (EPI) improves return of circulation after out of hospital cardiac arrest (OHCA). These beneficial cardiac effects are not accompanied by improved neurological survival possibly due to EPI induced microvascular effects and critical brain ischemia. We hypothesized that these dose-dependent adverse EPI effects may be mitigated by targeted temperature management (TTM) such that the relative benefit of TTM is greater at higher EPI doses. Methods: This was a retrospective cohort study of adult non-traumatic OHCA patients in Seattle and King County, Washington from 2008-2018, who were unconscious at hospital admission. We used logistic regression to assess the relationship among EPI dose, TTM, and survival to hospital discharge, and survival with favorable neurological status (Cerebral Performance Category (CPC) 1 or 2). The model evaluated whether TTM modified the association of increasing EPI dose using an interaction term between TTM and EPI dose. Results were stratified by initial shockable vs non-shockable rhythm. Results: Of 5254 eligible patients, the median EPI dose was 2.0 mg (IQR 1.0 - 3.0); 3052 (58%) received TTM. In all, 2177 (41%) survived to discharge, and 1889 (36%) survived with CPC 1-2. Increasing dose of EPI was associated with a decreasing likelihood of survival (OR 0.58, [95% CI 0.55-0.61] for each additional mg of EPI) and CPC 1-2 (OR 0.56, [0.53-0.59]). The dose-dependent EPI association was modified by TTM. After adjustment for Utstein covariates, for each additional mg of EPI, TTM was associated with a relative stepwise improvement in odds of survival (interaction OR 1.35, [1.23, 1.49]) and CPC 1-2 (OR 1.34, [1.21, 1.50]) (Figure). This interaction was consistent among shockable and non-shockable OHCA (Figure). Conclusions: We observed an interaction between TTM and EPI dose such that the beneficial association of TTM increased with increasing EPI dose, suggesting TTM may attenuate the adverse effects of higher dose EPI.

Abstract 9450: Shockable Rhythm at Hospital Arrival as the Predictor of Favorable Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Pei-I Su
Keyword(s):  
Logistic Regression ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Multiple Logistic Regression ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Arrival ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome

Introduction: For OHCA patients without ROSC under standard ALS, extracorporeal cardiopulmonary resuscitation (ECPR) was the only chance. However, ECPR was invasive and costed tremendous resources. This study aimed to analyze the predictor of favorable neurological outcome at hospital discharge (FO, cerebral performance category 1-2). Hypothesis: In OHCA patients receiving ECPR, shockable rhythm at hospital arrival could serve as predictor of FO. Method: This was a single center retrospective study which enrolled 126 OHCA patients receiving ECPR between January 2012 to December 2019. Primary outcome was FO at hospital discharge. Predictors of FO were assessed by multiple logistic regression. Patients with initial shockable rhythm were analyzed according to the cardiac rhythm at hospital arrival. Result: Among OHCA patients receiving ECPR, FO at hospital discharge was 21%. Certain variables were associated with FO: witnessed collapse (P=0.014), bystander CPR (P=0.05), shorter no flow time(P=0.008), and shockable rhythm at hospital arrival (78% vs. 49%;P=0.009). Initial shockable rhythm did not differ significantly (85% vs. 71% ;P=0.15). Multiple logistic regression showed that shockable rhythm at hospital arrival was the only predictor of FO (OR, 3.012; 95% CI, 1.06-8.53; P=0.038). Patients with initial shockable rhythm represented a heterogenous group. The group with shockable rhythm at hospital arrival had 30% of FO, which was significantly higher than 17% in PEA group, and 6% in asystole group (Graph 1). Patients who remained shockable had higher percentage of witnessed arrest, shorter arrest-hospital time, less metabolic disturbance, and hence higher percentage of FO. Conclusion: In OHCA patients receiving ECPR, shockable rhythm at hospital arrival could predict favorable neurological outcome at discharge more precisely than initial shockable rhythm. ECPR selection criteria should take the rhythm at hospital arrival into consideration.

Abstract 458: Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Lyra R Clark ◽  
Robyn McDannold ◽  
Margaret Mullins ◽  
Bentley Bobrow
Keyword(s):  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Pause Duration ◽  
Outcome Data ◽  
Adverse Outcomes ◽  
Accelerometer Data ◽  
Shockable Rhythm ◽  
State Quality ◽  
Favorable Neurological Outcome ◽  
The Impact

Introduction: AHA guidelines emphasize the importance of limiting pauses during CPR to less than 10 seconds due to the association of interruptions in chest compressions (CC) with adverse outcomes. Previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause in CC with lower odds of survival, though these analyses were restricted to patients with initial shockable rhythm. The aim of this analysis is to investigate the association between CC pause duration and patient outcomes in all-rhythm OHCA. Methods: OHCA cases from three EMS Agencies in Arizona between Jan 2016-Dec 2016 (n=229) were analyzed. De-identified prehospital patient data were linked to outcome data as part of the state quality program. Pauses calculated from CPR pad accelerometer data were defined by a minimum duration of 1000 ms. Mean pause duration was calculated by case as the average of all pauses, while longest pause duration was defined as the single longest pause in CC. Descriptive statistics and multivariate logistic regression was performed in STATA 15.1. Primary outcome measures defined were ROSC, survival-to-discharge, and favorable neurological outcome (Cerebral Performance Category 1 or 2). Covariates included in the statistical model include time in CPR, age, witnessed arrest, initial shockable rhythm, bystander CPR, and CPR quality. Results: A total of 37.1% of patients (n=85) achieved prehospital ROSC, 12.7% (n=29) survived, and 10.5% (n=24) had favorable neurological outcome. Average mean and longest pause duration was 8.13 + 0.76 s and 24.93 + 2.84 in survivors with favorable neurological outcome compared to 9.21 + 0.47 s and 35.56 + 3.55 s in non-survivors. Mean pause duration was associated with survival (adjusted OR 0.89, 95% CI 0.80-0.99) and favorable neurological outcome (adjusted OR 0.83, 95% CI 0.72-0.97). Longest pause duration was associated with favorable neurological outcome (adjusted OR 0.97, 95% CI 0.94-1.00). Conclusions: Prolonged pauses in CC during prehospital resuscitation was associated with worse survival and neurological function in OHCA patients with all cardiac rhythms. Pause duration should be kept as brief as possible due to the impact upon outcomes regardless of presenting cardiac rhythm.

Changes in the Expression of Proteasome Genes in Tumor Cells Following Short-Term Proteasome Inhibitor Therapy Predicts Survival in Multiple Myeloma Treated with Bortezomib-Containing Multi-Agent Chemotherapy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 733-733
Author(s):  
John D. Shaughnessy ◽  
Pingping Qu ◽  
Ricky Edmondson ◽  
Damir Herman ◽  
Yiming Zhou ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcome ◽  
Tumor Cell ◽  
Tumor Cells ◽  
Single Agent ◽  
Test Dose ◽  
Risk Groups ◽  
Low Risk ◽  
Short Term

Abstract Introduction: The mechanism of action and resistance to chemotherapy is poorly understood and measures of efficacy typically rely on clinical outcome data. Recent advances suggest that prospective gene expression profiling (GEP) can be used to more accurately define not only short-term but lasting treatment benefits. We recently reported that baseline tumor cell gene signatures, encompassing 70 and as few as 17 genes, can discriminate risk groups of myeloma patients both in the untreated and previously treated settings. However, a subset of predicted low-risk cases followed an aggressive clinical course accompanied by a shift from 70-gene-defined low-to high-risk over time, either reflecting clonal evolution or outgrowth of aggressive clones present, but undetectable, at diagnosis. Accurately identifying this patient population is a first step in preempting such transformation. We hypothesized that changes in gene expression patterns of tumor cells following a short term in-vivo challenge with a single agent chemotherapeutic might expose these latently aggressive cells. Unlike in-vitro testing, clinical drug administration also allows for assessing tumor cell perturbation in the context of host interactions. Building on recent observations that clinical outcome in myeloma patients could be correlated with 48hr GEP changes induced in vivo following single agent administration of thalidomide, lenalidomide, and dexamethasone, we now examined whether such short-term tumor-cell GEP and proteomic alterations could fine-tune clinical outcome prediction beyond the well established 70-gene-based baseline prediction model. Methods: Affymetrix U133Plus2.0 microarray analysis and mass spectrometry were performed on CD138-enriched tumor cells prior to and 48hr following a single test-dose application of bortezomib at 1.0mg/m2 in 142 newly diagnosed patients with MM. A total of 1051 genes (P < .005) were differentially expressed at 48 hours. Both change in expression, adjusting for baseline expression, and post-drug expression levels of each gene were examined for correlations with event-free survival in a Cox proportional hazards model. Post-drug expression was chosen and 113 genes were retained (p <= .05). The difference of the mean log2 expression of genes with hazard ratios (HR) of < 1.0 (favorable) and genes with HR >=1 (unfavorable) was used to create a score which, in the context of running log rank statistics, was used to classify patients into high- and low-risk groups. The independent prognostic power of the score for event-free and overall survival was investigated, together with baseline prognostic variables, by multivariate analysis. This method was tested in a 10-fold cross-validation procedure using the same data set. The model is currently being validated in an independent set of 100 cases and results will be reported. Results: Changes in the expression of proteasome genes, and their related proteins, predominated a list of 113 outcome-related genes. A high-risk score, associated with upregulation of proteasome genes, seen in 24% of cases, was associated with median survival of less than 24 months, dramatically contrasting with a 3-year survival estimate of greater than 80% in the 76% in whom proteasome genes were not activated (p<0.0001). The cross-validated post-bortezomib score was an independent predictor of outcome in multivariate analysis of standard and genetic variables, including the well established and validated baseline 70-gene risk score. Importantly, 12% of patients in the 70-gene model-defined low-risk category were upgraded to high-risk by the 113-gene post-bortezomib model, with poor outcomes resembling those in the 70-gene-defined high-risk baseline model. Moreover, the 113-gene post-bortezomib score alone accounted for an unprecedented 57% of outcome variability by R2 statistics, with hazard ratio values of 5.45 for overall and 7.84 for event-free survival. Conclusions: The rapid activation of proteasome genes and their corresponding proteins in MM cells within 48hr of a single bortezomib test-dose exposure as an indicator of poor clinical outcome suggests a novel and perhaps central mechanism of resistance to this new class of cancer therapeutics and perhaps standard genotoxic agents, which were part of the overall treatment. We are now testing the hypothesis whether the high-risk associated with the post-bortezomib proteasome activation can be overcome by higher doses of bortezomib or the addition of agents targeting other critical pathways.

P1701Sex-related difference in receiving bystander cardiopulmonary resuscitation and clinical outcome among out-of-hospital cardiac arrest patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ichihara ◽  
A Hirayama ◽  
Y Tahara ◽  
S Yasuda ◽  
T Noguchi ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Neurological Status ◽  
Female Patients ◽  
Related Difference ◽  
Shockable Rhythm ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Male Patients ◽  
To Receive ◽  
Hospital Cardiac Arrest

Abstract Background Early studies from US and Europe have reported that female out-of-hospital cardiac arrest (OHCA) patients were less likely to receive bystander cardiopulmonary resuscitation (CPR). However, little is known about sex-related difference in receiving CPR and clinical outcome among adult OHCA patients in Japan. Methods This study was a nation-wide, population-based observational study of OHCA in Japan from 2011 to 2015. We included all adult cardiogenic OHCA patients. We excluded patients witnessed by emergency medical services (EMS) from the present analysis. To account for the age-related difference, we stratified by age category: 18–39, 40–64, 65–79, and ≥80. To examine the association between patient sex and neurological outcome at 30-day, we fitted multivariable logistic regression model with adjustment for age, bystander CPR status, first document rhythm, dispatcher instruction and EMS response time. Results There were 339,317 adult cardiogenic, not EMS-witnessed OHCA patients (median age, 80; female, 43.5%) in Japan from 2011 to 2015. Overall, 171,122 (50.4%) received CPR by citizen, 34,283 (10.1%) had initial shockable rhythm, and 11,421 (3.4%) had favorable neurological status at 30-day. Female patients were more likely to receive bystander CPR (vs. male; 53.8% vs. 47.8%), and were less likely to have initial shockable rhythm (5.2% vs. 13.9%) and favorable neurological status at 30-day (1.8% vs. 4.6%) (all; p<0.001). With stratification by age category, elderly female patients (aged ≥65) were more likely to received bystander CPR (P<0.001), whereas male patients were more likely to received bystander CPR among patients aged <40. Multivariable logistic regression analysis showed that female patients had a lower rate of favorable neurological status at 30-day, compared to male patients in all age categories (all; P<0.05). Sex difference in bystander CPR Overall Male (n=191,672) Female (n=147,645) p-value All (n=339,317) 50.4% 47.8% 53.8% <0.001 Aged 18–39 (n=6,216) 56.0% 56.9% 53.5% 0.02 Aged 40–64 (n=50,320) 48.5% 48.5% 48.3% 0.69 Aged 65–80 (n=105,141) 46.5% 45.5% 48.3% <0.001 Aged ≥80 (n=177,640) 53.2% 49.0% 56.7% <0.001 OR for neurological outcome at 30-day Conclusion Unlike the situation in Europe and US, female OHCA patients, especially elderly female, were more likely to receive bystander CPR in Japan. However, female patients had worse clinical outcome after OHCA. Further investigations including in-hospital treatment are needed to clarify the sex-difference in clinical outcome after OHCA. Acknowledgement/Funding None

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