Abstract 11372: A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Andy T Tran ◽  
Anthony Hart ◽  
John Spertus ◽  
Philip Jones ◽  
Bryan McNally ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Risk Adjustment ◽  
Quality Measures ◽  
Coronary Intervention ◽  
Spontaneous Circulation ◽  
Logistic Regression Models ◽  
Adjustment Model ◽  
Risk Adjustment Model ◽  
Hospital Cardiac Arrest

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

Abstract 2227: Results of Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction Patients Following Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Timothy D Henry ◽  
Sue Duval ◽  
Michael R Mooney ◽  
Katie M Menssen ◽  
Christopher E Kapsner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
Neurological Impairment ◽  
Spontaneous Circulation ◽  
Primary Pci ◽  
Anoxic Brain Injury ◽  
Major Predictor ◽  
Hospital Cardiac Arrest

Background: Patients with cardiac arrest associated with STEMI are routinely excluded from clinical trials and therefore, almost no data exist regarding their outcomes with primary PCI. Patients with out of hospital cardiac arrest (OOHCA) are a particularly high-risk cohort and the appropriate reperfusion strategy for these patients is controversial. Methods/Results: We determined the outcomes of patients who sustained a cardiac arrest prior to primary PCI in 1,500 consecutive patients with STEMI admitted to or transferred to a regional PCI center. Overall 159(10.6%) STEMI patients sustained a cardiac arrest prior to PCI, including 47 (3.1%) with OOHCA. The in-hospital, 30-day and 1-year mortality for patients without cardiac arrest, cardiac arrest excluding OOHCA and patients with OOHCA are included in table . 53.3% of the deaths in OOHCA were related to anoxic brain injury compared to 9.1% of the deaths in patients with in-hospital cardiac arrest (p<0.003). Thirty-six percent of patients with OOHCA underwent a cooling protocol (return of spontaneous circulation and persistent neurologic impairment) with a 41% in-hospital mortality. Conclusions: Cardiac arrest prior to PCI (including both OOHCA and in-hospital) in patients with STEMI is a major predictor for in-hospital mortality. Patients with cardiac arrest who survive to discharge subsequently do well. OOHCA has a higher mortality than in-hospital cardiac arrest and the majority of deaths are due to anoxic brain injury. Still, nearly 70% of OOHCA survived to discharge without neurological impairment.

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.

Abstract 341: A Simple Prognostic Tool for In-Hospital Death in Patients Presenting with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Andy T Tran ◽  
Anthony J Hart ◽  
John Spertus ◽  
Philip Jones ◽  
Ali O Malik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Risk Score ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Hospital Death ◽  
St Elevation ◽  
Hospital Cardiac Arrest

Background: In the emergent setting of ST-Elevation Myocardial Infarction (STEMI) complicating out-of-hospital cardiac arrest (OHCA), decisions for immediate coronary angiography are made when the likelihood of hospital survival is unknown. Estimating the risk of mortality at the time of hospital arrival might inform decisions for primary percutaneous coronary intervention. Methods: From the Cardiac Arrest Registry to Enhance Survival (CARES), we included adult OHCA patients from 2013-2018 presenting to hospitals with a STEMI. We developed a predictive model for in-hospital mortality using multivariable logistic regression to derive a scoring tool that was internally validated with bootstrap methods. Results: Of 7120 patients with OHCA and STEMI admitted at a hospital (mean age 62±13.2 years, 27% female), 3159 (44.4%) died during hospitalization. Higher age, unwitnessed arrest, non-shockable cardiac arrest rhythm, no sustained return of spontaneous circulation (ROSC) at the time of hospital admission, and resuscitation time on scene were most predictive of mortality (C-index, 0.82). Using the model β coefficients, we developed an integer risk score ranging from 0 to 10 points, corresponding to observed mortality rates of 5% to 100% (Figure 1). The odds of in-hospital mortality doubled for each 1-unit score increase (odds ratio, 2.01; 95% CI, 1.94-2.09; p<0.0001), and a score of ≥6, involving ~15% of patients, was associated with ≥85% in-hospital mortality risk. Conclusions: This risk score, based on simple prehospital characteristics, stratifies the range of in-hospital mortality from 5% to nearly 100% in OHCA patients with STEMI at the time of hospital presentation. The benefits of such a model in decision-making for immediate coronary angiography should be prospectively studied.

scholarly journals An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA)

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S67-S73
Author(s):  
Matthew Kelham ◽  
Timothy N Jones ◽  
Krishnaraj S Rathod ◽  
Oliver Guttmann ◽  
Alastair Proudfoot ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
Stepwise Logistic Regression ◽  
Coronary Syndrome ◽  
Before And After ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Baseline Demographic

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre. This study aimed to compare the short-term mortality of patients admitted with an OHCA before-and-after the merger of services had taken place and admission criteria were relaxed, which led to managing OHCA in higher volume. Methods: We retrospectively analysed the data of OHCA patients pre- and post-merger. Baseline demographic and medical characteristics were recorded, along with factors relating to the cardiac arrest. The primary endpoint was in-hospital mortality. Results: OHCA patients ( N =728; 267 pre- and 461 post-merger) between 2013 and 2018 were analysed. Patients admitted pre-merger were older (65.0 vs. 62.4 years, p=0.027), otherwise there were similar baseline demographic and peri-arrest characteristics. There was a greater proportion of non-acute coronary syndrome-related OHCA admission post-merger (10.1% vs. 23.4%, p=0.0001) and a corresponding decrease in those admitted with ST-elevation myocardial infarction (80.2% vs. 57.0%, p=0.0001) and those treated with percutaneous coronary intervention (78.8% vs. 54.0%, p=0.0001). Despite this, in-hospital mortality was lower post-merger (63.7% vs. 44.3%, p=0.0001), which persisted after adjustment for demographic and arrest-related characteristics using stepwise logistic regression ( p=0.036) between the groups. Conclusion: Despite an increase in non-acute coronary syndrome-related OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit of a cardiac arrest centre model of care.

P1700Atrial fibrillation with CRBBB highly predict hospital mortality in the AMI patients presenting with out-of-hospital cardiac arrest after return of spontaneous circulation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y.-H Liu ◽  
Y.-C Wu ◽  
J.-L Lin
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Arrest ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Spontaneous Circulation ◽  
Bundle Branch Block ◽  
Return Of Spontaneous Circulation ◽  
Qrs Duration ◽  
Hospital Cardiac Arrest

Abstract Approximately 70% of survivals of out-of-hospital cardiac arrest (OHCA) have coronary artery disease, with acute vessel occlusion observed in 50%. The use of ECG to predict mortality and neurological outcomes in acute myocardial infarction (AMI) patients successfully resuscitated for OHCA has not been well-determined. Between May, 2016 and July, 2018, 1428 consecutive patients with OHCA visited the emergency department of Far Eastern Memorial Hospital, New Taipei City, Taiwan. A total number of 117 patients with return-of-spontaneous-circulation (ROSC) were diagnosed of AMI, mostly confirmed by coronary angiography. The mean age was 60.0±13.6 (mean SD) with male gender 105/117. Endpoint was mortality in hospital. The hospital mortality rate was 44.4%. Wide QRS duration (>120ms; 48.1%), complete right bundle branch block (33.3%) and atrial fibrillation (59.3%) occurred frequently in the first ECG of post-rescuscitation patients. Patient with wide QRS duration (correlation coefficient, CC: 0.350; p=0.074) and atrial fibrillation (CC: 0.287; p=0.147) had a trend towards higher mortality rate. Complete right bundle branch block (CRBBB) on the first ECG post resuscitation (CC: 0.632; p<0.001) and ST depression on first ECG post resuscitation (CC: 0.481; p=0.011) were associated with worse outcome (Mortality). Shockable rhythm (Ventricular tachycardia or fibrillation) during CPR (CC: −0.635; p<0.001), and sinus rhythm on first ECG (CC: −0.474; p=0.012) were associated better outcome (survival and neurological recovery). The combination two ECG characteristics of atrial fibrillation and CRBBB on the first ECG post resuscitation was highly associated with in-hospital mortality (CC: 0.725; p<0.001). It had a 66.7% sensitivity, 93.3% specificity, 88.9% positive predictive value, and 78.9% negative predictive value for predicting mortality. In conclusion, atrial fibrillation with CRBBB on the first ECG post resuscitation is the best predictors for unfavorable neurological outcome and mortality.

scholarly journals LO71: For patients suffering from out-of-hospital cardiac arrest, is survival influenced by the capabilities of the receiving hospital?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S52
Author(s):  
A. Cournoyer ◽  
E. Notebaert ◽  
L. De Montigny ◽  
M. Iseppon ◽  
S. Cossette ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
First Responders ◽  
Coronary Intervention ◽  
Spontaneous Circulation ◽  
Time Of Day ◽  
Absolute Difference ◽  
Supraglottic Airway ◽  
Multivariate Logistic Regression Model ◽  
Hospital Cardiac Arrest

Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) are frequently transported to the closest hospital after return of spontaneous circulation (ROSC). Percutaneous coronary intervention (PCI) is often indicated as a diagnostic and therapeutic procedure following OHCA. This study aimed to determine the association between the type of destination hospital (PCI-capable or not) and survival to discharge for patients with OHCA and prehospital ROSC. We hypothesized that being transported to a PCI-capable hospital would be associated with a higher survival to discharge. Methods: The present study used a registry of adult OHCA between 2010 and 2015 in Montréal, Canada. We included adult patients with non-traumatic OHCA and prehospital ROSC. The association of interest was evaluated with a multivariate logistic regression model to control for demographic and clinical variables (age, gender, time of day, initial rhythm, witnessed arrest, bystander CPR, presence of first responders or advanced care paramedics, prehospital supraglottic airway placement, delay before paramedics’ arrival). Assuming a survival rate of 40% and 75% of the variability explained by other factors included in the model, more than 1200 patients needed to be included to detect an absolute difference of 10% in survival between both groups with a power of more than 90%. Results: A total of 1691 patients (1140 men and 551 women) with a mean age of 64 years (standard deviation 17) were included, of which 1071 (63%) were transported to a PCI-capable hospital. Among all patients, 704 patients (42%) survived to hospital discharge. We observed a significant independent association between survival to discharge and being transported to a PCI-capable hospital (adjusted odds ratio [AOR] 1.46 [95% confidence interval 1.09-1.96]) after controlling for confounding variables. Having an initial shockable rhythm and presence of first responders also increased survival to discharge (AORs 3.67 [95% confidence interval 2.75-4.88] and 1.53 [95% confidence interval 1.12-2.09], respectively). Conclusion: Patients experiencing ROSC after OHCA could benefit from a direct transport to a PCI-capable hospital. This benefit might also be related to unmeasured interventions other than PCI these hospitals can provide (e.g. high-level intensive care or cardiovascular surgery).

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