Abstract 12185: Impact of Cardiac Arrest Centers on the Survival of Nontraumatic Out-of-Hospital Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jun Wei Yeo ◽  
Celeste Z Ng ◽  
Amelia X Goh ◽  
Jocelyn F Gao ◽  
Nan Liu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Meta Analysis ◽  
High Volume ◽  
Sensitivity Analyses ◽  
Shockable Rhythm ◽  
Meta Analyses ◽  
Favorable Neurological Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: The role of cardiac arrest centers (CAC) in out-of-hospital cardiac arrest (OHCA) is uncertain, especially since CACs are inconsistently defined. This study seeks to address knowledge gaps by assessing the impact of CACs on nontraumatic OHCA patients as a whole and among specific subgroups. Methods: In this review, Medline, Embase, and Cochrane CENTRAL were searched from inception to 9 March 2021. Studies were included if they compared CAC vs non-CAC among adult patients with nontraumatic OHCA. CACs were explicitly named by study authors and were capable of appropriate interventions. Data abstraction and quality assessment were independently conducted by two authors, and a third author resolved discrepancies. Main outcomes were survival and survival with favorable neurological outcome at hospital discharge or at 30 days. Meta-analyses were performed for adjusted (aOR) and crude (OR) odds ratios. Sensitivity analyses were conducted for wider definitions of CAC such as high volume centers or improved post-resuscitation care, and subgroups analysed to account for heterogeneity. Results: The search yielded 4544 articles, and 36 were included for analysis. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR = 1.88, 95% CI 1.53 to 2.31), even when including high volume centers (aOR = 1.68, 95% CI 1.30 to 2.16), or when including improved care centers (aOR = 2.16, 95% CI 1.76 to 2.64) as CACs. Survival significantly increased with treatment at CAC (aOR = 1.92, 95% CI 1.59 to 2.31), even when including high volume centers (aOR = 1.74, 95% CI 1.38 to 2.18), or when including improved care centers (aOR = 1.97, 95% CI 1.71 to 2.26) as CACs. The effect on favorable neurological outcome was more pronounced among patients with shockable rhythm (p = 0.03) and on survival among patients without prehospital ROSC (p = 0.005). Findings were robust to sensitivity analyses, with no publication bias detected. Conclusion: CACs improved survival and neurological outcomes for nontraumatic OHCA patients despite varying definitions of CAC. Patients with shockable rhythms and without prehospital ROSC appeared to yield greater benefit from CACs. Evidence for bypassing hospitals or inter-hospital transfer remains inconclusive.

scholarly journals Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

2021 ◽  
Author(s):  
Jun Wei Yeo ◽  
Zi Hui Celeste Ng ◽  
Amelia Xin Chun Goh ◽  
Jocelyn Fangjiao Gao ◽  
Nan Liu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Meta Analysis ◽  
High Volume ◽  
Spontaneous Circulation ◽  
Sensitivity Analyses ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Interhospital Transfer ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups. Methods and Results Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected. Conclusions Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.

Abstract 208: A Comprehensive Simulation-Based Training for E-CPR Improves the Neurological Outcome in Patients With Refractory Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Takashi Unoki ◽  
Daisuke Takagi ◽  
Yudai Tamura ◽  
Hiroto Suzuyama ◽  
Eiji Taguchi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Intervention Period ◽  
Post Intervention ◽  
Shockable Rhythm ◽  
Time Period ◽  
Simulation Based ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: Prolonged conventional cardiopulmonary resuscitation (C-CPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Extracorporeal cardiopulmonary resuscitation (E-CPR) has been utilized as a rescue strategy for patients with cardiac arrest unresponsive to C-CPR. However, the indication and optimal duration to switch from C-CPR to E-CPR are not well established. In addition, the opportunities to develop teamwork skills and expertise to mitigate risks are few. We thus developed the implementation protocol for the E-CPR simulation program, and investigated whether the faster deployment of extracorporeal membrane oxygenation (ECMO) improves the neurological outcome in patients with refractory OHCA. Methods: A total of 42 consecutive patients (age 58±16 years, male ratio 90%, and initial shockable rhythm 64%) received E-CPR (3% of OHCA) during the study period. Among them, 32 (76%) were deployed ECMO during the pre-intervention time period (Pre: from January 2012 to September 2017), whereas 10 (24%) were deployed during the post-intervention time period (Post: October 2017 to May 2019). We compared the door to E-CPR time, collapse to E-CPR time, 30-day mortality, and favorable neurological outcome (Cerebral Performance Categories 1, 2) between the two periods. Results: There was no significant difference in age, the rates of male sex and shockable rhythm, and the time form collapse to emergency room admission between the two periods. The door to E-CPR time and the collapse to E-CPR time were significantly shorter in the post-intervention period compared to the pre-intervention period (Pre: 39 min [IQR; 30-50] vs. Post: 29 min [IQR; 22-31]; P=0.007, Pre: 76 min [IQR; 58-87] vs. Post: 59 min [IQR; 44-68]; P=0.02, respectively). The 30-day mortality was similar between the two periods (Pre: 88% vs. Post: 80%; P=0.6). In contrast, the rate of favorable neurological outcome at the time of discharge was significantly higher in post-intervention period (Pre: 0% vs. Post: 20%; P=0.01) compared to the pre-intervention period. Conclusion: A comprehensive simulation-based training for E-CPR seems to improve the neurological outcome in patients with refractory OHCA patients.

Impact of Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation with Out-of-Hospital Cardiac Arrest: A Systemic Review and Meta-Analysis

2020 ◽  
Vol 35 (4) ◽  
pp. 372-381
Author(s):  
Junhong Wang ◽  
Hua Zhang ◽  
Zongxuan Zhao ◽  
Kaifeng Wen ◽  
Yaoke Xu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Meta Analysis ◽  
Systemic Review ◽  
Cochrane Library ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Impact ◽  
Hospital Cardiac Arrest

AbstractObjective:This systemic review and meta-analysis was conducted to explore the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on bystander cardiopulmonary resuscitation (BCPR) probability, survival, and neurological outcomes with out-of-hospital cardiac arrest (OHCA).Methods:Electronically searching of PubMed, Embase, and Cochrane Library, along with manual retrieval, were done for clinical trials about the impact of DA-BCPR which were published from the date of inception to December 2018. The literature was screened according to inclusion and exclusion criteria, the baseline information, and interested outcomes were extracted. Two reviewers assessed the methodological quality of the included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated by STATA version 13.1.Results:In 13 studies, 235,550 patients were enrolled. Compared with no dispatcher instruction, DA-BCPR tended to be effective in improving BCPR rate (I2 = 98.2%; OR = 5.84; 95% CI, 4.58-7.46; P <.01), return of spontaneous circulation (ROSC) before admission (I2 = 36.0%; OR = 1.17; 95% CI, 1.06-1.29; P <.01), discharge or 30-day survival rate (I2 = 47.7%; OR = 1.25; 95% CI, 1.06-1.46; P <.01), and good neurological outcome (I2 = 30.9%; OR = 1.24; 95% CI, 1.04-1.48; P = .01). However, no significant difference in hospital admission was found (I2 = 29.0%; OR = 1.09; 95% CI, 0.91-1.30; P = .36).Conclusion:This review shows DA-BPCR plays a positive role for OHCA as a critical section in the life chain. It is effective in improving the probability of BCPR, survival, ROSC before admission, and neurological outcome.

Abstract 152: Effect of the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Tadashi Ashida ◽  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Shigemasa Tani ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Shockable Rhythm ◽  
Class Iib ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: The 2010 guidelines have stressed that systematic post-cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological outcome. However, the 2010 guidelines showed that induced therapeutic hypothermia may be considered for comatose adult patients with ROSC after out-of-hospital cardiac arrest (OHCA) with an initial rhythm of non-shockable (Class IIb). It is unknown whether the post-cardiac arrest care for patients with non-shockable cardiac arrest contributed to favorable neurological outcome. The aim of the present study was to clarify the effects of the 2010 guidelines in patients with ROSC after cardiac arrest due to non-shockable rhythm, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA. Methods: From the data of this registry between 2005 and 2015, we included adult patients with ROSC after out-of-hospital non-shockable cardiac arrest due to cardiac etiology. Study patients were divided into three groups based on the different CPR guidelines; the era of the 2000 guidelines (2000G), the era of the 2005 guidelines (2005G), and the era of the 2010 guidelines (2010G). The endpoint was favorable neurological outcome at 30 days after OHCA. Results: The 31,204 patients who met the inclusion criteria comprised 25,045 with ROSC before arrival at the hospital and 6,259 with ROSC after hospital arrival without prehospital ROSC. Figure showed favorable neurological outcome at 30 days in the three groups. Moreover, multivariable analysis showed that the 2010 guidelines were an independent predictor of favorable neurological outcome at 30 days after OHCA, respectively (Figure). Conclusion: In the patients with ROSC after out-of-hospital non-shockable cardiac arrest, the 2010 guidelines were superior to the 2005 guidelines and the 2000 guidelines, in terms of neurological benefits.

Abstract 183: Public-Access Automated External Defibrillator Pad Application and Favorable Neurological Outcome After Out-of-Hospital Cardiac Arrest in Public Locations; A Prospective Population-Based Propensity-Score Matched Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Takefumi Kishimori ◽  
Takeyuki Kiguchi ◽  
Kosuke Kiyohara ◽  
Tasuku Matsuyama ◽  
Haruka Shida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Neurological Outcome ◽  
Public Access ◽  
Automated External Defibrillator ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Background: Randomized control trials or observational studies showed that the use of public-access automated external defibrillator (AED) was effective for patients with out-of-hospital cardiac arrest (OHCA). However, it is unclear whether public-access AED use is effective for all patients with OHCA irrespective of first documented rhythm. We aimed to evaluate the effect of public-access AED use for OHCA patients considering first documented rhythm (shockable or non-shockable) in public locations. Methods: From the Utstein-style registry in Osaka City, Japan, we obtained information on adult patients with OHCA of medical origin in public locations before emergency-medical-service personnel arrival between 2011 and 2015. The primary outcome was one-month survival with favorable neurological outcome. Multivariable logistic regression analysis was used to assess the association between the public-access AED pad application and favorable neurological outcome after OHCA by using one-to-one propensity score matching analysis. Results: Among 1743 eligible patients, a total of 336 (19.3%) victims received public-access AED pad application. The proportion of patients who survived one-month with favorable neurological outcome was significantly higher in the pad application group than in the non-pad application group (29.8% vs. 9.7%; adjusted odds ratio [AOR], 2.85; 95% confidence interval [CI], 1.73-4.68, AOR after propensity score matching, 2.83; 95% CI, 1.40-5.72). In a subgroup analysis, the AOR of patients with shockable or non-shockable rhythms was 3.36 (95% CI, 1.78-6.35) and 2.38 (95% CI, 0.89-6.34), respectively. Conclusions: Public-access AED pad application was associated with better outcome among OHCA patients with shockable rhythm and the trend was the same among those with non-shockable rhythm.

Abstract 340: Effect of the 2015 CPR Guidelines for Patients With Out-Of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm: Results From the All-Japan Utstein Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Eizo Tachibana ◽  
Naohiro Yonemoto ◽  
Yoshio Tahara ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Population Based ◽  
Inclusion Criteria ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Favorable Neurological Outcome ◽  
Population Based Registry ◽  
Hospital Cardiac Arrest

Background: The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA). Methods: From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm, PEA and asystole, as an initial rhythm. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G), and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Results: The 109,175 patients who met the inclusion criteria comprised 18,764 who received CPR based on 2015G and 90,411 who received CPR based on 2010G. The figure showed favorable neurological outcomes at 30 days in the two groups. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in 2015G patients as compared to 2010G patients was 1.28 (95%CI 1.11-1.46, p<0.001). Conclusion: In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.

scholarly journals Editor’s Choice-Effects of targeted temperature management on mortality and neurological outcome: A systematic review and meta-analysis

2017 ◽  
Vol 7 (5) ◽  
pp. 467-477 ◽  
Author(s):  
Dylan Stanger ◽  
Vesna Mihajlovic ◽  
Joel Singer ◽  
Sameer Desai ◽  
Rami El-Sayegh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Adult Survivors ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Shockable Rhythm ◽  
Poor Neurological Outcome ◽  
Meta Analyses ◽  
Hospital Cardiac Arrest ◽  
Quality Evidence

Aims: The purpose of this study was to conduct a systematic review, and where applicable meta-analyses, examining the evidence underpinning the use of targeted temperature management following resuscitation from cardiac arrest. Methods and results: Multiple databases were searched for publications between January 2000–February 2016. Nine Population, Intervention, Comparison, Outcome questions were developed and meta-analyses were performed when appropriate. Reviewers extracted study data and performed quality assessments using Grading of Recommendations, Assessment, Development and Evaluation methodology, the Cochrane Risk Bias Tool, and the National Institute of Health Study Quality Assessment Tool. The primary outcomes for each Population, Intervention, Comparison, Outcome question were mortality and poor neurological outcome. Overall, low quality evidence demonstrated that targeted temperature management at 32–36°C, compared to no targeted temperature management, decreased mortality (risk ratio 0.76, 95% confidence interval 0.61–0.92) and poor neurological outcome (risk ratio 0.73, 95% confidence interval 0.60–0.88) amongst adult survivors of out-of-hospital cardiac arrest with an initial shockable rhythm. Targeted temperature management use did not benefit survivors of in-hospital cardiac arrest nor out-of-hospital cardiac arrest survivors with a non-shockable rhythm. Moderate quality evidence demonstrated no benefit of pre-hospital targeted temperature management initiation. Low quality evidence showed no difference between endovascular versus surface cooling targeted temperature management systems, nor any benefit of adding feedback control to targeted temperature management systems. Low quality evidence suggested that targeted temperature management be maintained for 18–24 h. Conclusions: Low quality evidence supports the in-hospital initiation and maintenance of targeted temperature management at 32–36°C amongst adult survivors of out-of-hospital cardiac arrest with an initial shockable rhythm for 18–24 h. The effects of targeted temperature management on other populations, the optimal rate and method of cooling and rewarming, and effects of fever require further study.

scholarly journals Survival and neurological recovery after out-of-hospital cardiac arrest

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Jarakovic ◽  
S Bjelica ◽  
M Kovacevic ◽  
M Petrovic ◽  
S Dimic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Study Group ◽  
St Segment Elevation ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health challenge and although rate of intrahospital survival increased over the last 40 years, it still remains poor (from 8,6% in 1976-1999 to 9,9% in 2000-2019). Different studies report that introduction of mild therapeutic hypothermia (TTM) improves survival and neurological outcome in comatose patients after OHCA.  Purpose The aim of this research was to evaluate influence of pre-hospital predictors related to cardiopulmonary resuscitation (CPR), neurological status and ECG changes at admission and early percutaneous coronary intervention (PCI) performed within 24h of admission on intrahospital survival and neurological outcome of OHCA patients. Methods The research was conducted as a retrospective cohort study of data taken from the hospital registry on OHCA from January 2007 until November 2019. The analyzed factors were: bystander CPR, duration of CPR until return of ROSC, initial rhythm, responsiveness upon admission defined as Glasgow Coma Score (GCS)&gt;8, presence of ST segment elevation (STEMI) on electrocardiography (ECG) and early PCI. The favorable neurological outcome was defined as a cerebral performance category scale (CPC)≤2. Results The research included 506 survivors of OHCA. Cardiac arrest was witnessed in 412 (81.4%), bystander CPR was performed in 197 (38.9%), CPR lasted ≤20min in 291 (57.5%), initial rhythm was shockable in 304 (60.1%) of patients. At admission 387 (76.5%) were comatose (GCS &lt; 8) and TTM was introduced in 177 (45.7%) of patients. ECG upon admission showed STEMI in 176 (34.8%) and early PCI was performed in 145 (28.6%) of patients. In-hospital mortality in our study group was 281 (55.5%) and 185 (36.6%) of patients had favorable neurological outcome. Multivariate regression analysis showed that initial shockable rhythm (OR 3.391 [2.310-4.977], p &lt; 0.0005), early PCI (OR 0.368 [0.226-0.599], p &lt; 0.0005), duration of CPR ≤20min (OR 4.249 [2.688-6.718], p &lt; 0.0005) and GCS &gt; 8 (OR 0.194 [0.110-0.343], p &lt; 0.0005) were independent predictors of in-hospital survival. Independent predictors of favorable neurological outcome were: initial shockable rhythm (OR 3.301 [2.002-5.441], p&lt; 0.0005), STEMI on ECG upon admission (OR 0.528 [0.326-0.853], p = 0.009), duration of CPR ≤20min (OR 5.144 [3.090-8.565], p&lt; 0.0005) and GCS &gt; 8 (OR 0.152 [0.088-0.260], p&lt; 0.0005). Introduction of TTM improved both intrahospital survival (54.1% vs. 24.4%; p &lt; 0.0005) and neurological outcome (33.5% vs. 11.6%; p &lt; 0.0005) in patients with initial shockable rhythm. Conclusion In our study group of OHCA patients of any origin, initial shockable rhythm, duration of CPR ≤20min and GCS &gt; 8 at admission influenced both intrahospital survival and favorable neurological outcome. Introduction of TTM significantly improved both survival and neurological outcome in comatose patients with initial shockable rhythm.

Abstract 169: Association Between Time to First Administration of Epinephrine After Defibrillation and Outcome in Out-Of-Hospital Cardiac Arrest Patients With Shockable Rhythm

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Shoji Kawakami ◽  
Yoshio Tahara ◽  
Teruo Noguchi ◽  
Satoshi Yasuda ◽  
Naohiro W Yonemoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Multivariate Logistic Regression Analysis ◽  
Population Based ◽  
Emergency Medical Service Personnel ◽  
Epinephrine Administration ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: In out-of-hospital cardiac arrest (OHCA) patients during shockable rhythm, the epinephrine administration after second defibrillation is recommended by the 2015 ILCOR/CoSTR guidelines. However, there is insufficient evidence regarding the proper timing of epinephrine administration particularly in relation to defibrillation. Hypothesis: The timing of epinephrine after first defibrillation (D-E interval) was associated with clinical outcome in OHCA patients. Methods: Between 2011 and 2016, we enrolled 753,025 OHCA patients from nationwide prospective population-based registry in Japan. Following exclusion criteria, a total of 1,559 patients with witnessed by bystanders and shockable rhythm on the initial electrocardiogram who administrated epinephrine after defibrillation by emergency medical service personnel and obtained return of spontaneous circulation in prehospital setting were eligible for the study. We evaluated the association between D-E interval and favorable neurological outcome (cerebral performance category: 1 or 2) at 30 days. To evaluate predictor for better neurological outcome, study patients were categorized as every 2 minutes up to 20 minutes, and more than 20 minutes. Results: Patients with favorable neurological outcome were 22% (N=348). Patients with favorable neurological outcome had a shorter D-E interval than those with non-favorable neurological outcome (7.9±4.1vs 10.2±5.3 min, p<0.001). Multivariate logistic regression analysis showed that D-E interval at more than 10 minutes, when D-E interval at 2 to 3 minutes as defined reference, was a significant predictor for non-favorable neurological outcome ( Table ). Conclusion: Delayed epinephrine administration after first defibrillation (D-E interval >10 minutes) was significantly associated with non-favorable neurological outcome.

Abstract 155: Effect of the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest Due to Shockable Rhythm

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Yoji Watanabe ◽  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Shigemasa Tani ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome ◽  
Population Based Registry ◽  
Hospital Cardiac Arrest

Background: The 2010 guidelines have stressed that systematic post-cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological outcome. Especially, the 2010 guidelines recommended that comatose adult patients with ROSC after out-of-hospital ventricular fibrillation (VF) cardiac arrest should be induced therapeutic hypothermia (Class I). However, it is unknown whether the post-cardiac arrest care which was recommended by the 2010 guidelines contributed to favorable neurological outcome. The aim of the present study was to clarify the effects of the 2010 guidelines in patients with ROSC after cardiac arrest due to shockable rhythm, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest (OHCA). Methods: From the data of this registry between 2005 and 2015, we included adult patients with ROSC after out-of-hospital shockable cardiac arrest due to cardiac etiology. Study patients were divided into three groups based on the different CPR guidelines; the era of the 2000 guidelines (2000G), the era of the 2005 guidelines (2005G), and the era of the 2010 guidelines (2010G). The primary endpoint was favorable neurological outcome at 30 days after OHCA. Results: The 30,518 patients who met the inclusion criteria comprised 24,729 with ROSC before arrival at the hospital and 5,789 with ROSC after hospital arrival without prehospital ROSC. Figure showed favorable neurological outcome at 30 days in the three groups. Moreover, multivariable analysis showed that the 2010 guidelines were an independent predictor of favorable neurological outcome at 30 days after OHCA, respectively (Figure). Conclusion: In the patients with ROSC after out-of-hospital shockable cardiac arrest, the 2010 guidelines were superior to the 2005 guidelines and the 2000 guidelines, in terms of neurological benefits.

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